LET and ACL Reconstruction: Extra Stability for High-Risk Knees

Posted on: September 1st, 2026 by Our Team

As discussed in my recent Instagram post, lateral extra-articular tenodesis—commonly called LET—is a procedure that can be added to ACL reconstruction to provide additional rotational stability.

A standard ACL reconstruction replaces the torn ligament inside the knee. While this works well for many patients, some knees have a greater tendency to rotate or “pivot,” placing added stress on the reconstructed ACL. LET helps support the outside of the knee and control this rotational movement.

During the procedure, the surgeon typically uses a small strip of the patient’s iliotibial band, or IT band. The tissue remains attached near the upper shin and is secured along the outer side of the thigh bone. It acts as a secondary stabilizer, sharing some of the forces that might otherwise be placed on the ACL graft.

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Who May Benefit From LET?

LET is not necessary for every ACL reconstruction. It is most often considered for patients with a higher risk of graft failure or continued rotational instability, including:

• Young, active athletes
• Athletes returning to cutting or pivoting sports
• Patients with significant looseness on the pivot-shift examination
• Patients with generalized ligamentous laxity or knee hyperextension
• Patients undergoing revision ACL reconstruction after a previous graft failure

Research suggests that adding LET in appropriately selected high-risk patients can reduce persistent rotational instability and lower the chance of ACL graft failure. However, the decision should always be individualized based on the patient’s anatomy, examination, sport, graft choice and long-term goals.

A Personalized Approach to ACL Surgery

Successful ACL treatment involves more than repairing a ligament. It requires understanding how the injury occurred, identifying each patient’s risk factors and creating a plan that supports a safe return to activity.

For some patients, ACL reconstruction alone is the right approach. For others, adding LET may provide an important extra layer of protection. A thorough evaluation with a sports medicine knee specialist can help determine which option is most appropriate for you.

To discuss an ACL injury or learn whether LET may be part of your treatment plan, schedule a consultation with Dr. Kevin Collon in Los Angeles.