Does Anterior Cruciate Ligament Reconstruction with Lateral Extra-Articular Tenodesis Improve Objective Stability and Functional Outcomes in Athletes with Isolated Anterior Cruciate Ligament Tear? A Randomized Controlled Trial

Abstract

Numerous studies have compared anterior cruciate ligament reconstruction (ACLR) with and without lateral extra-articular tenodesis (LEAT) in patients with anterior cruciate ligament (ACL) tears and other associated pathologies. These associated conditions significantly affect the outcomes in terms of function and stability. Athletes with isolated ACL tears and high pivot shifts represent a unique and uncommon subgroup. Despite the presence of a high-grade pivot shift, these individuals do not exhibit associated meniscal, chondral, or ligamentous laxity. We have carefully selected this group of patients to evaluate objective stability and functional outcomes, focusing on the comparison between ACLR with and without LEAT in athletes by excluding ligamentous laxity and meniscal tears. This randomized controlled clinical trial compared the functional outcomes and side-to-side instability of ACLR with or without modified Lemaire technique. Patients in this study had the following inclusion criteria: (1) less than 40 years old, (2) isolated ACL tear without meniscal injury or ligamentous laxity, (3) high pivot shift grade (2 and 3), and (4) athlete patients. The main outcomes were the comparison of functional knee scores (Lysholm and International Knee Documentation Committee [IKDC]) and objective stability, measured by the KT1000 Lachmeter. Patients were evaluated every 3 months postoperatively for at least 1 year of follow-up. Postoperative complications or failure to regain knee function were recorded. Patients were considered to have failed surgery if they experienced a persistent pivot shift, and this was confirmed radiologically. A total of 41 patients were included in our study, randomized into two groups. Group A included 20 patients treated with arthroscopic anatomical single-bundle ACLR combined with the modified Lemaire technique. Group B included 21 patients who underwent anatomical single-bundle ACLR only. Two patients were lost during follow-up in group B and were excluded from statistical analysis. At 12 months of follow-up, patients treated with arthroscopic anatomical single-bundle ACLR combined with the modified Lemaire technique showed a statistically significant improvement in functional knee scores (Lysholm score and IKDC; p = 0.011 and 0.003, respectively) and significant improvements in the side-to-side KT 1000 difference (p = 0.002). No complications were experienced, except for one case (1/19) in group B that failed and refused further interventions. ACLR with LEAT, in athletes with isolated anterior cruciate ligament tears without meniscal tears or ligamentous laxity (Beighton score ≥ 5) with high pivot shift (grade 2 and 3), resulted in a significant improvement in objective stability and functional outcomes (Lysholm and IKDC scores) at the 12-month follow-up.

Keywords

anterior cruciate ligament - tear - reconstruction, lateral extra-articular tenodesis - functional and stability outcome

Publication History

Received: 03 June 2025

Accepted: 23 December 2025

Article published online:
16 January 2026

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