Lateral extra-articular procedures (LEAPs) have evolved from a controversial adjunct to ACL reconstruction into an increasingly evidence-supported tool for managing rotational instability and reducing graft failure in appropriately selected patients.

In this episode of The Sports Docs Podcast, Drs. Henry Ellis and Bonnie Gregory join us live from the AOSSM Annual Meeting to discuss where lateral augmentation fits in modern ACL management. They explore the evidence behind lateral extra-articular tenodesis (LET), patient selection and indications, potential complications, LET versus anterolateral ligament reconstruction (ALLR), surgical technique, fixation strategies, and rehabilitation considerations.

The conversation also highlights the Arthrex Knee FiberTak system, including how an all-suture anchor platform may address some of the limitations of traditional LET fixation.

Key Topics Discussed

• Why add a lateral augmentation procedure to ACL reconstruction?
  • Evidence demonstrating reduced ACL graft rupture and improved rotational stability
  • The role of LEAP in high-risk primary ACL reconstruction and revision ACL surgery
  • Impact on return to sport and pre-injury level of play
  • Emerging evidence supporting the cost-effectiveness of LET
• Understanding the potential downsides
  • Lateral-sided pain and hardware irritation
  • Hematoma and need for hardware removal
  • Early quadriceps weakness
  • Concerns regarding over-constraint and long-term degenerative changes
  • Whether adding a lateral procedure meaningfully changes postoperative recovery
• Who actually needs a LEAP?
  • Young, active athletes
  • High-grade pivot shift or anterior laxity
  • Knee hyperextension
  • Revision ACL reconstruction
  • Athletes returning to pivoting sports
  • Hamstring autograft ACL reconstruction
  • Multiple coexisting risk factors
  • Chronic ACL deficiency and other emerging indications
• LEAP in elite athletes
  • How professional team physicians are approaching lateral augmentation
  • Current practice patterns in elite and professional sports
  • The balance between maximizing graft survivorship and avoiding unnecessary procedures
• LET versus ALL reconstruction
  • Differences in surgical approach
  • Clinical outcomes and graft failure
  • Rotational stability
  • Operative time, cost, and potential complications
  • Why surgeons may favor one technique over the other
• Modern LET surgical technique
  • Graft harvest and preparation
  • Relationship of the graft to the LCL
  • Femoral fixation
  • Knee position during fixation
  • Graft orientation and isometry
  • Avoiding over-constraint
  • Importance of anatomic attachment sites
  • Management of the IT band at the conclusion of the procedure

Spotlight: Arthrex Knee FiberTak

The episode takes a closer look at the Knee FiberTak platform and its application in lateral augmentation.

The guests discuss how an all-suture anchor platform may offer advantages compared with traditional fixation methods, including:

• Reduced hardware prominence
• Bone preservation
• Potentially decreased risk of tunnel convergence
• Low-profile fixation
• Ergonomic instrumentation designed specifically for the knee
• Multiple fixation configurations for different surgical applications

The Knee FiberTak family includes:

• Double-Knotless Anchor
• Double-Knotted Anchor
• Hybrid Anchor
• InternalBrace Anchor
• Knee FiberTak Button

The discussion explores how surgeons select between different configurations and how a versatile fixation platform can improve efficiency and adaptability in the operating room.

Rehab & Return to Sport

The episode concludes with a practical discussion of rehabilitation following ACL reconstruction with lateral augmentation.

While the addition of a LEAP generally does not dramatically alter standard postoperative restrictions, the guests emphasize several priorities:

• Regaining full knee extension
• Restoring quadriceps strength and activation
• Monitoring early quadriceps recovery
• Maintaining appropriate progression through rehabilitation
• Preparing the athlete for a safe and successful return to sport

Summary

LEAPs are no longer simply a historical technique being revisited. Contemporary evidence suggests that appropriately selected patients—particularly young, high-risk athletes, patients with significant rotational instability, revision ACL cases, and athletes returning to pivoting sports—may benefit from lateral augmentation as part of a comprehensive ACL reconstruction strategy.

The challenge for modern sports surgeons is determining who truly benefits, which technique is most appropriate, and how to perform the procedure without introducing unnecessary morbidity or over-constraint.

Disclaimer

This episode is sponsored by Arthrex. The discussion includes Arthrex products, including the Knee FiberTak system. The views and opinions expressed by the guests are their own and are intended for educational purposes.