This RCT followed 80 knees for a mean of 19.4 years after randomization to BTB ACL reconstruction alone or with a modified Lemaire lateral extra-articular tenodesis (gracilis). It compares long-term patient-reported outcomes, graft survival, and compartment-specific osteoarthritis between the two techniques.
The LET debate comes down to this: does adding a lateral tenodesis protect the graft without harming the joint? Nearly 20 years of RCT data say the functional answer is no — no IKDC benefit, no Lysholm benefit, no return-to-sport benefit.
When counseling a high-risk patient about LET addition (revision setting, high-grade pivot shift, cutting/pivoting athlete), be transparent: the graft-protective trend (13% vs 29% failure) is real but unproven at this sample size. The lateral OA signal (59% vs 22%) is the number that should give you pause, especially if you are also performing a lateral meniscectomy at the same sitting.
The authors' technical note matters clinically: fix the gracilis tenodesis at 30° of flexion in neutral rotation. Not external rotation as classically described. To minimize lateral compartment overconstraint. If you are adding LET and the lateral meniscus needs resection, recognize that combination likely drives the worst OA outcomes in this series.
This RCT followed 80 knees for a mean of 19.4 years after randomization to BTB ACL reconstruction alone or with a modified Lemaire lateral extra-articular tenodesis (gracilis). It compares long-term patient-reported outcomes, graft survival, and compartment-specific osteoarthritis between the two techniques.
The LET debate comes down to this: does adding a lateral tenodesis protect the graft without harming the joint? Nearly 20 years of RCT data say the functional answer is no — no IKDC benefit, no Lysholm benefit, no return-to-sport benefit.
When counseling a high-risk patient about LET addition (revision setting, high-grade pivot shift, cutting/pivoting athlete), be transparent: the graft-protective trend (13% vs 29% failure) is real but unproven at this sample size. The lateral OA signal (59% vs 22%) is the number that should give you pause, especially if you are also performing a lateral meniscectomy at the same sitting.
The authors' technical note matters clinically: fix the gracilis tenodesis at 30° of flexion in neutral rotation. Not external rotation as classically described. To minimize lateral compartment overconstraint. If you are adding LET and the lateral meniscus needs resection, recognize that combination likely drives the worst OA outcomes in this series.