Editorial Commentary: Anterior Cruciate Ligament Reconstruction Alone Is Not Sufficient in Anterolateral Complex Injury: Extra-Articular Augmentation (Lateral Extra-Articular Tenodesis [LET] or Anterolateral Ligament [ALL] Reconstruction) Allows Surgeons to Indicate Tight (LET) or Just Right (ALL) on a Case-by-Case Basis.

Extra-articular augmentation has become an essential consideration in contemporary anterior cruciate ligament reconstruction (ACL) surgery. The verdict is still out on the extra-articular augmentation procedure of choice to accompany ACL surgery in the treatment of anterolateral rotatory instability. Anterolateral ligament reconstruction and lateral extra-articular tenodesis) are 2 common methods with clinical outcome data to support their use. Both procedures have demonstrated clinical effectiveness in reducing the rate of recurrent ACL tear/recurrent knee instability. Biomechanics studies to date have reached varied conclusions; however, a growing body of research including the study discussed here suggests both procedures enhance stability in the setting of surgical treatment of anterolateral rotatory instability, whereas ACL reconstruction alone is not sufficient in the setting of anterolateral complex injury. I suggest surgeons carefully consider when to augment ACL surgery with an extra-articular procedure and feel there is a place for both procedures. When extra constraint is indicated, I recommend lateral extra-articular tenodesis. When patient athletic demands may be lesser and a less-invasive procedure is indicated, anterolateral ligament augmentation of ACL reconstruction is my preference.