Glossary
Lateral extra-articular tenodesis (LET)
Quick answer
Lateral extra-articular tenodesis, or LET, is an extra procedure on the outer side of the knee, using a strip of the iliotibial band to control twisting that an ACL graft alone may not fully stop. Doha knee surgeon Dr. Pablo Gelber at Aman Hospital adds it for selected high-risk patients.
What it is
The ACL controls forward and rotational movement of the shin. After a tear, some knees have marked rotational looseness, felt as the knee shifting or giving way on pivoting. In an LET, a narrow strip of the iliotibial band, the strong tissue on the outside of the thigh, is detached at one end, passed under the outer collateral ligament and fixed to the thighbone.
It works outside the joint, as a supporting check-rein for the new ACL.
Why it matters for patients
Research in young athletes returning to pivoting sports has shown that adding an LET can reduce the risk of ACL graft failure. That is relevant to footballers, basketball and padel players.
It adds a separate incision on the outer thigh and some extra soreness early on. Rehabilitation is broadly similar to standard ACL reconstruction.
Who may be offered it
It is considered for revision ACL surgery, young patients in pivoting sports, knees with a very positive pivot-shift test, generalised ligament laxity, or certain bone shapes. Not everyone needs it; the decision depends on examination under anaesthesia and your activity goals.
Frequently asked questions
Does LET make ACL recovery longer?
In most protocols the overall timeline is similar to ACL reconstruction alone. The outer thigh may be sore for a few extra weeks.
Is LET the same as an anterolateral ligament reconstruction?
Both aim to control rotation on the outer side of the knee. An LET uses the iliotibial band, while anterolateral ligament reconstruction usually uses a separate graft; they are related but different techniques.
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