A soft-tissue procedure added to ACL reconstruction to reduce rotational knee laxity.
LET is an adjunct procedure done alongside ACL reconstruction, where an iliotibial band strip or separate graft is routed from the lateral femoral condyle to the tibia to add a checkrein against anterolateral rotation. It supplements the ACL graft rather than replacing it, specifically targeting the rotational (pivot-shift) component of instability that an isolated ACL graft may not fully control.
It shapes the surgical planning conversation for patients with high-grade pivot shift, those undergoing revision ACL surgery, or those returning to high-demand cutting/pivoting sport, since these are the groups where added rotational control may reduce graft failure risk. Clinicians should know whether LET was performed because it can influence expected knee stiffness, rehab emphasis, and return-to-sport timelines compared with isolated ACL reconstruction.
In practice it is identified from the operative note rather than measured independently in clinic; postoperatively, clinicians track anterolateral rotational stability through the pivot-shift test alongside standard ACL-reconstruction stability and function assessments. Rehab progression may account for the additional lateral-sided soft tissue work, though specific modifications vary by surgeon and program.
Indications are not fully standardized, and evidence on which patients truly benefit over isolated ACL reconstruction is still evolving, so use varies considerably between surgeons and centres. There is a risk of over-application in patients who would have done well with ACL reconstruction alone, so clinicians should avoid assuming LET is required or beneficial for every high-demand or revision case without individualized surgical reasoning.
This guide was auto-drafted and is pending editorial review.