This international modified Delphi consensus asks when a lateral extra-articular procedure (LEAP) should be added to ACL reconstruction. Fifty-five knee surgeons from 17 countries graded 21 patient-selection statements across three rounds. Part I covers indications; a companion Part II addresses technique and complications.
When you see a young, active patient under 25 heading for a hamstring-autograft ACL reconstruction, the panel's unanimous answer is to add a lateral extra-articular procedure to protect the graft. Build a mental risk profile rather than relying on one trigger. Grade 3 pivot shift, knee hyperextension, revision surgery, and return to pivoting sports each independently justify a LEAP.
Secondary factors matter when they stack. Posterior tibial slope >12°, contralateral ACL history, chronic deficiency, and skeletally immature status push toward augmentation, and statement 36 formalizes that several weak indications together can cross the threshold.
Know the gray zones for boards and for honest consent. Small graft (<8 mm), female sex, isolated imaging signs, and concomitant meniscal work did not reach consensus, so these stay individualized. This is Level V expert opinion shaped by high-volume, LEAP-favorable surgeons, so weight it as a framework rather than proof.
This international modified Delphi consensus asks when a lateral extra-articular procedure (LEAP) should be added to ACL reconstruction. Fifty-five knee surgeons from 17 countries graded 21 patient-selection statements across three rounds. Part I covers indications; a companion Part II addresses technique and complications.
When you see a young, active patient under 25 heading for a hamstring-autograft ACL reconstruction, the panel's unanimous answer is to add a lateral extra-articular procedure to protect the graft. Build a mental risk profile rather than relying on one trigger. Grade 3 pivot shift, knee hyperextension, revision surgery, and return to pivoting sports each independently justify a LEAP.
Secondary factors matter when they stack. Posterior tibial slope >12°, contralateral ACL history, chronic deficiency, and skeletally immature status push toward augmentation, and statement 36 formalizes that several weak indications together can cross the threshold.
Know the gray zones for boards and for honest consent. Small graft (<8 mm), female sex, isolated imaging signs, and concomitant meniscal work did not reach consensus, so these stay individualized. This is Level V expert opinion shaped by high-volume, LEAP-favorable surgeons, so weight it as a framework rather than proof.