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Level I clinical evidence suggests that adding an iliotibial (ITB) \u2013 based LET can meaningfully reduce graft rupture rates while improving control of pivot shift \u2013 type instability. The 2025 International Consensus on lateral extra-articular procedures (LEAPs) supports LET\/anterolateral augmentation particularly for revision ACLR, high-grade pivot shift, generalized laxity or hyperextension\/recurvatum, and young athletes returning to pivoting\/contact sports. The consensus also mentions that modern LEAPs have low complication rates, do not typically require altered rehabilitation, and have not shown a consistent signal for increased lateral compartment osteoarthritis when contemporary technique principles are followed. Finally, despite the variety of described constructs (modified Lemaire variants, other ITB-based tenodeses, and anatomic ALL reconstruction), current literature does not demonstrate a single universally superior technique. Instead, success appears to be linked to correct patient selection, adherence to key technical principles (appropriate graft routing &amp; low-tension fixation), and age or skeletal \u2013 maturity \u2013 appropriate modifications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Summary<\/jats:title>\n                    <jats:p>When applied selectively in high-risk patients, adding a lateral extra-articular tenodesis to ACL reconstruction can improve rotational control and reduce re-injury, but current evidence does not support a single universally superior LET construct. Optimal results depend on appropriate indications, careful technique, and tailoring the approach to patient factors such as age, sport demands, laxity profile, and skeletal maturity.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s12178-026-10028-9","type":"journal-article","created":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T02:22:39Z","timestamp":1775096559000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Extra-articular Tenodesis for ACL Reconstruction: Who Needs it and is there a Superior Technique?"],"prefix":"10.1007","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1289-4959","authenticated-orcid":false,"given":"Enejd","family":"Veizi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6289-2783","authenticated-orcid":false,"given":"Lucy","family":"Oliver-Welsh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1398-9626","authenticated-orcid":false,"given":"Christos","family":"Koutserimpas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-8645-0901","authenticated-orcid":false,"given":"Emrah","family":"Imat","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4731-4333","authenticated-orcid":false,"given":"Alan","family":"Getgood","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,2]]},"reference":[{"issue":"1","key":"10028_CR1","doi-asserted-by":"publisher","first-page":"e101","DOI":"10.3928\/01477447-20260114-02","volume":"49","author":"P Gunturu","year":"2026","unstructured":"Gunturu P, Rohl MR, Wetzel CN, Owoeye AO, Boghdady AA, Korb I, et al. 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