# Prevention of Postoperative Graft Rupture by Additional Lateral Extra-articular Tenodesis in Anterior Cruciate Ligament Reconstruction: A Case Series of Four Patients

## TL;DR

Adding lateral extra-articular tenodesis during ACL surgery may help prevent graft rupture in high-risk patients.

## Contribution

This case series demonstrates the protective effect of lateral extra-articular tenodesis in preventing ACL graft rupture.

## Key findings

- Four patients with additional LET avoided ACL graft re-rupture after traumatic events.
- LET may provide robust protection against postoperative graft failure in high-risk individuals.

## Abstract

Anterior cruciate ligament (ACL) reconstruction is commonly performed; however, re-injury and graft failure remain significant concerns, particularly in high-demand individuals. Lateral extra-articular tenodesis (LET) has recently attracted attention as an adjunct to ACL reconstruction to reduce rotational instability and improve surgical outcomes. In this report, we describe four patients who underwent primary ACL reconstruction with additional LET. Despite experiencing significant traumatic knee events postoperatively, all four patients avoided ACL graft re-rupture. These cases suggest LET has a robust protective effect against ACL graft rupture, especially in patients at high risk for postoperative injury.