A LET is typically incorporated in conjunction with ACL repair whenever anterolateral complex (ALC) deficiency resulting in rotatory laxity is noted. This reestablishes pivot control by eliminating anterolateral displacement, as long as posteromedial integrity has been confirmed. From a biomechanical and safety stanpoint, this added procedure assists in limiting tibial rotation relative to the femur, in conjunction with ACL reconstruction to correct anterior tibial translation, subsequently serving to reduce overload to the ACL graft.

I would recommend the following article from Dr. Robert LaPrade's group for further information on rotatory instability, and outcomes of various surgical LET techniques:

Slette EL, Mikula JD, Schon JM, Marchetti DC, Kheir MM, Turnbull TL, LaPrade RF. Biomechanical Results of Lateral Extra-articular Tenodesis Procedures of the Knee: A Systematic Review. Arthroscopy. 2016;32(12):2592-2611.

@ Michael C. Meyers,

Thanks a lot for your clear and lucid response.

Hi Munish, in my practice I add a LET/ALL if they have a very large pre-operative pivot shift, have additional risk factors for re-rupture, or after ACLR there is any residual pivot on table. A LET/ALL is also useful in the revision setting. Best wishes.

Hi Manish. Following the stability trial results I have started doing let in all hamstring acl s under 25, sportsmen and in revisions. Bw

@ Sven Putnis thanks a lot

Thanks a lot @ Manish Kiran