Editorial Commentary: Lateral Extra-articular Augmentations in Anterior Cruciate Ligament Reconstruction Reduce Anterior Cruciate Ligament Graft Failure and Secondary Meniscectomy and Are Indicated for Anterior Cruciate Ligament Primary and Revision Reconstruction.

In the past decade, increasing evidence supports knee lateral extra-articular tenodesis or anterolateral ligament reconstruction for anterolateral rotational instability in patients requiring anterior cruciate ligament (ACL) reconstruction. Extra-articular augmentation reduces the risk of ACL graft failure, particularly in high-risk populations. Recent research shows a 3-fold lower risk of failure and a lower rate of secondary meniscectomy. Indications include revision ACL reconstruction, pivoting sports participation, high-grade pivot shift, hyperlaxity or knee hyperextension, anterolateral complex injury on imaging evaluation, chronic ACL tear, meniscus repair, increased anterior translation (>7 mm), and posterior tibial slope >12°. We perform extra-articular procedures for every patient at high risk for rerupture, which currently accounts for more than 90% of our primary ACL reconstruction cases. Lateral extra-articular procedures may also be a viable option for treating patients who have undergone isolated ACL reconstruction and have symptomatic minor instabilities and an intact ACL graft.