The STABILITY Study is a multicenter RCT (n=618, ages 14-25) testing whether adding a modified Lemaire lateral extra-articular tenodesis (LET) to single-bundle hamstring ACLR reduces failure in high-risk patients. Patients required at least 2 of 3 risk factors: grade 2+ pivot shift, desire to return to pivoting sports, or generalized ligamentous laxity. Primary outcome was composite clinical failure — persistent rotatory laxity or graft rupture — at 2 years.
For years, LET was largely abandoned in North America after a small, underpowered 1991 study suggested no benefit and raised concerns about overconstraint and lateral compartment arthritis. The STABILITY Study is the first adequately powered RCT to directly answer whether LET adds value in the patients who need it most.
When you have a patient aged 14-25 with an ACL tear who meets at least 2 of these criteria — grade 2+ pivot shift, desire to return to pivoting sports, or generalized ligamentous laxity (Beighton ≥4 or genu recurvatum >10°). Adding a modified Lemaire LET to hamstring reconstruction should be the default plan.
Tell patients up front: the operated knee will hurt more for the first 3-6 months, but by one year there is no meaningful pain difference. Staple removal is needed in about 1 in 30 cases.
Long-term osteoarthritis risk from LET remains unresolved in this cohort, though 20-year European data and a meta-analysis cited in the paper found no increased OA rate. Something to monitor as the STABILITY cohort matures.
The STABILITY Study is a multicenter RCT (n=618, ages 14-25) testing whether adding a modified Lemaire lateral extra-articular tenodesis (LET) to single-bundle hamstring ACLR reduces failure in high-risk patients. Patients required at least 2 of 3 risk factors: grade 2+ pivot shift, desire to return to pivoting sports, or generalized ligamentous laxity. Primary outcome was composite clinical failure — persistent rotatory laxity or graft rupture — at 2 years.
For years, LET was largely abandoned in North America after a small, underpowered 1991 study suggested no benefit and raised concerns about overconstraint and lateral compartment arthritis. The STABILITY Study is the first adequately powered RCT to directly answer whether LET adds value in the patients who need it most.
When you have a patient aged 14-25 with an ACL tear who meets at least 2 of these criteria — grade 2+ pivot shift, desire to return to pivoting sports, or generalized ligamentous laxity (Beighton ≥4 or genu recurvatum >10°). Adding a modified Lemaire LET to hamstring reconstruction should be the default plan.
Tell patients up front: the operated knee will hurt more for the first 3-6 months, but by one year there is no meaningful pain difference. Staple removal is needed in about 1 in 30 cases.
Long-term osteoarthritis risk from LET remains unresolved in this cohort, though 20-year European data and a meta-analysis cited in the paper found no increased OA rate. Something to monitor as the STABILITY cohort matures.