Editorial Commentary : Lateral Extra‐articular Tenodesis in Quadriceps Tendon Anterior Cruciate Ligament Reconstruction: Improved Rotational Control, but Are We Redefining Failure?

Abstract

Persistent rotational instability following anterior cruciate ligament reconstruction (ACLR) remains one of the greatest unresolved challenges in modern sports medicine, particularly in young athletes returning to cutting and pivoting sports. Although contemporary ACLR techniques frequently provide excellent subjective outcomes, residual rotatory laxity continues to be associated with graft failure, revision surgery, and failure to return to preinjury athletic performance. Against this background, lateral extra‐articular tenodesis has experienced a substantial resurgence as an adjunct procedure aimed at improving rotational control. High‐level evidence in young, high‐risk patients undergoing hamstring autograft ACLR has showed that lateral extra‐articular tenodesis augmentation reduced graft rupture rates and persistent rotatory laxity. As the use of quadriceps tendon autograft continues to increase, it is increasingly important to determine whether the benefits observed with hamstring ACLR extend to quadriceps tendon ACLR. This evolving evidence base has significant implications for graft choice and outcomes in high‐risk athletic populations.