{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T17:04:07Z","timestamp":1785344647945,"version":"3.55.0"},"reference-count":22,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T00:00:00Z","timestamp":1778803200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T00:00:00Z","timestamp":1778803200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["arthroscopyjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Arthroscopy"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Lateral extra\u2010articular tenodesis (LET) is an adjunct to anterior cruciate ligament reconstruction (ACLR) designed to improve rotational stability and reduce graft failure, particularly in young, high\u2010risk athletes returning to pivoting sports. With growing clinical evidence supporting reduced failure rates, recent cost analyses suggest lateral extra\u2010articular procedures at the time of primary ACLR may be cost\u2010effective. In this context, routine LET begins to appear not only reasonable but financially responsible. Surgeons, patients, hospital systems, and insurers are understandably drawn to this promise of cost\u2010effectiveness. However, variability in graft choice, fixation methods, surgeon experience, and patient risk profiles introduces cost differences that are difficult to standardize. Even small inefficiencies or complications can weaken the theoretical savings projected by simplified models. Routine LET may appear cost\u2010effective under certain assumptions, principally alongside hamstring autograft ACLR. However, these conditions may not fully reflect contemporary ACLR practice across diverse surgical environments and patient populations. Until economic analyses incorporate current graft utilization patterns (i.e., quadriceps and\/or patellar tendon autograft), varied fixation techniques (e.g., suture anchors), patient\u2010specific indications, and the realities of surgical reproducibility, surgeons should approach recommendations for routine LET with scrutiny rather than automatic adoption.<\/jats:p>","DOI":"10.1002\/arj.70269","type":"journal-article","created":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T10:36:08Z","timestamp":1778841368000},"page":"1405-1407","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["<i>Editorial Commentary<\/i>\n                    : Cost\u2010Effective, Until It Isn't: Variability in Lateral Extra\u2010articular Tenodesis Techniques Challenges Cost Analyses for Primary Anterior Cruciate Ligament Reconstruction"],"prefix":"10.1002","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-9048-1084","authenticated-orcid":false,"given":"Jonathan A.","family":"Marter","sequence":"first","affiliation":[{"name":"Wake Forest University School of Medicine  Winston\u2010Salem North Carolina U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8054-9401","authenticated-orcid":false,"given":"Mina","family":"Entessari","sequence":"additional","affiliation":[{"name":"Wake Forest University School of Medicine, Atrium Health Wake Forest Baptist Medical Center  Winston\u2010Salem North Carolina U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1442-212X","authenticated-orcid":false,"given":"Brian R.","family":"Waterman","sequence":"additional","affiliation":[{"name":"Wake Forest University School of Medicine, Atrium Health Wake Forest Baptist Medical Center  Winston\u2010Salem North 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