Editorial Commentary: Indications for Lateral Extra-Articular Tenodesis in Primary Anterior Cruciate Ligament Reconstruction

Lateral extra-articular tenodesis and other anterolateral procedures improve patient outcomes when combined with anterior cruciate ligament reconstruction. Failure rates are >50% lower in young patients at high risk of reinjury. We defined patients at high risk as those aged 14 to 25 years with 2 or more factors of the following criteria: 1) returning to contact pivoting sport, 2) high-grade anterolateral rotatory laxity, as measured by pivot shift test (grade 2 or higher), and 3) generalized ligamentous laxity (Beighton score greater than 4) or knee hyperextension recurvatum of greater than 10 degrees. Other indications may include Segond fracture, chronic anterior cruciate ligament lesion, radiographic lateral femoral notch sign, and lateral coronal plane laxity. A clearer understanding of indications determined by a comprehensive clinical assessment and risk stratification is needed. As indications continue to be "stretched," we need to better understand the role of lateral extra-articular tenodesis and when to employ it in our practice.