ABOUT THIS EPISODE
On today’s episode of The Sports Docs Podcast, we’re discussing the 2026 Orthopaedic Journal of Sports Medicine article, “The Impact of Lateral Extra-Articular Tenodesis on Knee Range of Motion After Pediatric Anterior Cruciate Ligament Reconstruction,” by Hamad and colleagues from UCLA.
The use of lateral extra-articular tenodesis (LET) alongside ACL reconstruction continues to increase, particularly in young athletes at high risk for reinjury. While growing evidence suggests that LET can improve rotational stability and reduce ACL graft failure, questions remain about whether adding an extra-articular restraint may increase the risk of postoperative stiffness.
In this retrospective cohort study, the authors evaluated 412 pediatric ACL reconstructions, including 167 patients who underwent ACL reconstruction with LET. The primary outcome was restricted range of motion at three months, defined as a ≥5° extension deficit or ≥15° flexion deficit compared with the contralateral knee.
We discuss several key findings:
- Restricted range of motion at three months occurred in 16.8% of ACLR + LET patients compared with 10.2% following isolated ACL reconstruction.
- After adjustment for patient and surgical factors, LET was associated with approximately twice the odds of restricted postoperative motion.
- Female sex was the strongest predictor identified, with more than four times the odds of restricted motion.
- Most motion deficits involved flexion rather than extension.
- Although most patients with early motion loss did not require another procedure, 4.2% of the LET group underwent manipulation under anesthesia and/or lysis of adhesions compared with 0.4% of the isolated ACL group.
We also discuss why these findings should not discourage surgeons from performing LET in appropriately selected athletes.
Instead, the study highlights a potential trade-off between graft protection and early postoperative motion, reinforcing the importance of appropriate patient selection, careful LET positioning and tensioning, early restoration of knee motion, and close postoperative surveillance.
Finally, we review the limitations of this retrospective study and discuss how evolving LET indications, graft selection, fixation techniques, rehabilitation adherence, and surgical technique may influence these findings.
The takeaway: LET provides meaningful protection for the ACL graft in young, high-risk athletes—but surgeons and rehabilitation teams should remain vigilant about restoring motion and identifying patients who begin to fall behind early in recovery.
Article
Hamad et al. The Impact of Lateral Extra-Articular Tenodesis on Knee Range of Motion After Pediatric Anterior Cruciate Ligament Reconstruction. Orthopaedic Journal of Sports Medicine. 2026.
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