ACL Reconstruction Plus LET Procedure May Help Young Athletes Avoid Reinjury

An anterior cruciate ligament (ACL) tear can be a devastating injury for a young athlete, with a high risk for re-tear or graft failure after ACL reconstruction in athletes under age 25.

Researchers may have found a way to improve outcomes in this population: In the largest clinical trial of its kind, they have shown that ACL reconstruction combined with lateral extra-articular tenodesis (LET) may reduce this risk of re-tear or graft failure. The LET procedure creates a new ligament-like structure outside of the knee to provide additional support.

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“Although the LET procedure has shown potential in improving patient outcomes, a randomized clinical trial was needed to assess whether or not it reduces the risk of re-injury,” said Dr. Alan Getgood, a scientist at Lawson Health Research Institute and orthopaedic surgeon at the Fowler Kennedy Sport Medicine Clinic, both in London, Ontario, Canada.

Dr. Getgood led the STABILITY trial, which included 624 patients from 9 centers across Canada and Europe. Participants were under age 25, were scheduled for ACL reconstruction with a hamstring graft, and had a high risk for re-injury.

Patients were randomized to receive ACL reconstruction with or without the LET procedure. Re-injury occurred in 11% of patients who had undergone ACL reconstruction only, compared with 4% of patients who had undergone ACL reconstruction plus LET.

“Adding the LET procedure resulted in a 65% relative risk reduction for graft failure,” Dr. Getgood said. “Our results suggest patients under the age of 25 should consider the LET procedure when they have decided on ACL reconstruction using a hamstring graft.”

The research team studied a number of other outcomes including pain, athletic function, muscle strength, and return to sports. Although the LET procedure resulted in slightly higher levels of postoperative pain and slightly decreased muscle strength in the 3 months following surgery, these complications did not persist. There were no differences in outcomes between groups at 1 year and 2 years after surgery.

The STABILITY trial was funded by the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS). The findings were presented at the 2019 ISAKOS Biennial Congress, where the research group was awarded the Jan I. Gillquist Scientific Research Award for best scientific paper presented at the meeting.

Dr. Getgood and the STABILITIY team will also be recognized by the American Orthopaedic Society for Sports Medicine (AOSSM) with the O’Donoghue Award for best clinical-based research paper. The award was presented at the AOSSM’s Annual Meeting.

Dr. Getgood recently received funding from the Canadian Institutes of Health Research to conduct a follow-up study called the STABILITY 2 trial. The study will compare ACL reconstruction with and without LET using 2 other types of grafts: patellar tendon grafts and quadriceps tendon grafts.

“Our goal is to determine whether the choice of graft affects patient outcomes and whether or not LET should be used with either choice,” Dr. Getgoods said. “Ultimately, we hope to enable patients in getting back to the activities they love most.”


Heard MA, Bryant DM, Getgood A, et al. Anterior Cruciate Ligament Reconstruction with or without a Lateral Extra-Articular Tenodesis: Analysis of Complications from the ISAKOS-Sponsored Stability Study(Paper 26).Presented at the 2019 ISAKOS Biennial Congress, May 11-16, 2019, in Cancun, Mexico.

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