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Persistent rotatory laxity and graft failure remain important concerns after anterior cruciate ligament reconstruction, particularly in young patients returning to pivoting sports. The STABILITY randomized clinical trial tested whether adding a lateral extra-articular tenodesis to hamstring autograft ACL reconstruction could reduce this risk. More than 600 young, high-risk patients were randomized to ACL reconstruction alone or ACL reconstruction plus LET. At two years, the combined procedure produced a lower rate of the composite clinical-failure outcome and fewer graft ruptures. The study therefore provides strong evidence that LET can add meaningful rotational stability in appropriately selected patients. Importantly, the authors did not suggest that every ACL reconstruction needs an extra-articular procedure. The greatest rationale is in younger, active individuals with high-grade pivot shift, generalized ligamentous laxity or a high-risk sporting profile. The addition of LET introduces additional surgical considerations, and short-term pain was somewhat greater in some measures, but longer-term patient-reported outcomes were broadly similar. For everyday practice, the trial supports a risk-stratified approach: reserve combined ACLR plus LET for patients whose baseline risk of graft failure and rotational instability is sufficiently high to justify the added procedure.
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Persistent rotatory laxity and graft failure remain important concerns after anterior cruciate ligament reconstruction, particularly in young patients returning to pivoting sports. The STABILITY randomized clinical trial tested whether adding a lateral extra-articular tenodesis to hamstring autograft ACL reconstruction could reduce this risk. More than 600 young, high-risk patients were randomized to ACL reconstruction alone or ACL reconstruction plus LET. At two years, the combined procedure produced a lower rate of the composite clinical-failure outcome and fewer graft ruptures. The study therefore provides strong evidence that LET can add meaningful rotational stability in appropriately selected patients. Importantly, the authors did not suggest that every ACL reconstruction needs an extra-articular procedure. The greatest rationale is in younger, active individuals with high-grade pivot shift, generalized ligamentous laxity or a high-risk sporting profile. The addition of LET introduces additional surgical considerations, and short-term pain was somewhat greater in some measures, but longer-term patient-reported outcomes were broadly similar. For everyday practice, the trial supports a risk-stratified approach: reserve combined ACLR plus LET for patients whose baseline risk of graft failure and rotational instability is sufficiently high to justify the added procedure.
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