Short-term outcomes and rehabilitation following anterior cruciate ligament reconstruction with and without lateral extra-articular tenodesis in younger patients: a prospective comparison

Introduction: Anterior cruciate ligament reconstruction (ACLR) is commonly performed in the younger or active population, but failure rates have been disappointing in high-risk patients. Recently, lateral extra-articular procedures such as the modified Lemaire extra-articular tenodesis (LET) have been proposed to decrease failure rates, but knowledge on short-term rehabilitation, stiffness and isokinetic strength is limited. This study aimed to assess the short-term patient-reported outcomes (PROMs) and physical performance outcomes following ACLR with and without LET. Methods: A prospective study was performed among 152 patients aged 25 years undergoing hamstring autograft ACLR with or without modified Lemaire LET between 2019 and 2022 with minimum 1-year follow-up. PROMs (Tegner, International Knee Documentation Committee, Lysholm, NRS for pain, and EQ-5D) were compared between groups preoperatively and at 3, 6, 9, 12 and 24 months, while physical performance (range-of-motion (ROM), and limb symmetry indices (LSI) of isokinetic testing, single-leg and timed-6m hop) was compared up to 9 months postoperatively. Results: Baseline characteristics and outcomes were similar, except thicker grafts in the LET group (8.9 vs 8.7 mm, p=.047). At 3 months, Lemaire patients reported less pain (NRS pain 17.1 vs 35.6, p<.001), but at 6 months, Lemaire patients had inferior LSI for timed-6m hop (87% vs 96%, p=.003). At 9 months, Lemaire patients had similar return-to-sports, PROMs, and ROM, but had lower LSI for flexion endurance strength (88% vs 97%, p=.041). At 12 months, no differences were seen in PROMs. Conclusion: Patients undergoing ACLR with LET had less pain at 3 months, but worse LSI for timed-6m hop at 6 months and worse LSI for flexion endurance strength at 9 months. Both groups showed similar performance on all other outcomes, indicating that ACLR with LET is not associated with increased stiffness, complications or significant strength deficits. Level of evidence: Level II prospective study.

Publication History

Received: 18 March 2025

Accepted after revision: 26 September 2025

Accepted Manuscript online:
29 September 2025