Functional Outcomes Following ACL Reconstruction: A Comparison Between Isolated ACLR and Combined ACLR–LET Procedures

Abstract

ACL injuries cause significant knee instability in young, active individuals. While arthroscopic ACL reconstruction is effective, many patients retain rotational instability. Adding lateral extra-articular tenodesis (LET) may improve stability and reduce graft failure, especially in high-risk athletes. This study compares functional outcomes between isolated ACL reconstruction and ACL reconstruction with LET. Aim: To compare the functional outcomes of patients undergoing arthroscopic anterior cruciate ligament (ACL) reconstruction combined with lateral extra-articular tenodesis (LET) versus those undergoing isolated arthroscopic ACL reconstruction in the treatment of ACL injury. Material and methods: A comparative 18-month study on 40 ACL-injury patients assessed clinical and functional outcomes of isolated ACL reconstruction versus combined ACL reconstruction with lateral extra-articular tenodesis. Results: The findings indicate that although operative time was higher in the ACLR + LET group, postoperative complications—including superficial infection, stiffness, and graft failure—were low and similar in both groups. Return-to-sport results clearly favored Group A, with 75% achieving pre-injury performance compared to 50% in Group B. Knee stability was also better in the combined procedure group, especially evident by a significantly higher rate of negative pivot-shift tests, reflecting superior rotational control. Knee Society Scores were consistently higher in Group A at 6, 12, and 18 months, demonstrating enhanced functional recovery. Pain levels decreased in both groups, but Group A reported slightly lower VAS scores at 1 week and 1 month, suggesting improved early postoperative comfort. Overall, the results show that incorporating LET into ACL reconstruction enhances stability, function, and return-to-sport outcomes without increasing complication rates. Conclusion: ACLR combined with LET showed better functional outcomes, improved rotational stability, and higher return-to-sport rates than isolated ACL reconstruction. Both groups recovered well, but the LET group had slightly better range of motion, less pain, and no added complications. LET appears safe and beneficial for patients with high rotational instability.