{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,16]],"date-time":"2026-05-16T07:28:48Z","timestamp":1778916528750,"version":"3.51.4"},"reference-count":39,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T00:00:00Z","timestamp":1772150400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T00:00:00Z","timestamp":1772150400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["esskajournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Lateral extra\u2010articular tenodesis (LET) has been shown to improve rotational stability and clinical outcomes and to reduce graft failure rates in selected high\u2010risk patients. However, the comparative effects of deep (beneath\u2010LCL) and superficial (over\u2010LCL) LET techniques on clinical and biomechanical outcomes remain uncertain. This study aimed to compare the functional, kinematic, and strength outcomes of deep and superficial LET performed concomitantly with ACLR in patients with high\u2010grade pivot\u2010shift. It was hypothesised that superficial LET would result in clinical and biomechanical outcomes comparable to those of the deep LET technique.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This prospective, randomised, double\u2010blind comparative study included 24 male patients with isolated ACL rupture and pivot\u2010shift grades 2\u20133. Patients were divided equally into two treatment groups as ACLR with deep LET or superficial LET. All procedures used standardised quadrupled hamstring autografts. Clinical outcomes were assessed using the IKDC, Lysholm, and Tegner scores preoperatively and at 6 and 12 months. Biomechanical assessments included three\u2010dimensional running gait analysis and isokinetic tibial rotation strength testing at 6 months postoperatively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      All patients completed follow\u2010up with no graft ruptures. Both groups showed significant improvement in IKDC and Lysholm scores at 6 and 12 months (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05). The deep LET group demonstrated greater improvement in IKDC (86.5\u2009\u00b1\u20093.0 vs. 81.3\u2009\u00b1\u20096.7,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.022) and Lysholm (90.8\u2009\u00b1\u20092.9 vs. 85.8\u2009\u00b1\u20097.2,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.037) scores. Running gait analysis revealed reduced stance phase tibial rotation (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.035) and anterior translation (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.01) in the deep LET group, indicating superior dynamic control. Isokinetic torque recovery and Tegner activity levels (6.4 vs. 6.0,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.19) were comparable.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Concomitant deep and superficial LET techniques effectively restored knee stability and improved clinical outcomes after ACL reconstruction. However, the deep LET technique was associated with improved tibial rotational stability and more favourable patient\u2010reported outcomes in young, athletic male patients with high\u2010grade pivot\u2010shift.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>Level 1, randomised controlled trials with adequate statistical power to detect differences (narrow confidence intervals) and follow up &gt;80%.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ksa.70372","type":"journal-article","created":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T21:45:01Z","timestamp":1773006301000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Deep lateral extra\u2010articular tenodesis (LET) is associated with improved tibial internal rotational stability and favourable patient\u2010reported outcomes compared with superficial LET in high\u2010grade pivot\u2010shift male patients undergoing quadrupled hamstring autograft ACL reconstruction"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9963-5334","authenticated-orcid":false,"given":"Yavuz","family":"\u015eahbat","sequence":"first","affiliation":[{"name":"Department of Orthopaedics and Traumatology Erzurum Regional Training and Research Hospital Erzurum Turkey"},{"name":"Department of Orthopaedics and Traumatology Istinye University Bahcesehir Liv Hospital Istanbul Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5518-3938","authenticated-orcid":false,"given":"Nasuhi","family":"Altay","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology Erzurum Regional Training and Research Hospital Erzurum Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2537-0660","authenticated-orcid":false,"given":"Bar\u0131\u015f","family":"Kocao\u011flu","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery \u0130stanbul Acibadem Altunizade Hospital Istanbul Turkey"},{"name":"Department of Orthopedics and Traumatology Faculty of Medicine, Acibadem Mehmet Ali Aydinlar University Istanbul Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2962-3968","authenticated-orcid":false,"given":"Ozan","family":"Sever","sequence":"additional","affiliation":[{"name":"Atat\u00fcrk University Erzurum Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,2,27]]},"reference":[{"issue":"8","key":"e_1_2_12_2_1","doi-asserted-by":"crossref","DOI":"10.1177\/23259671211025494","article-title":"A surgical algorithm according to 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