Clinical Outcomes of Anterior Cruciate Ligament Reconstruction With and Without Lateral Extra-articular Tenodesis in Non-Athletic Patients: A Retrospective Comparative Study

Abstract Background: Lateral extra-articular tenodesis (LET) is increasingly used as an adjunct to anterior cruciate ligament reconstruction (ACLR) to address residual rotational instability and reduce the risk of graft failure. However, most available evidence has focused on young, athletic, or high-risk populations, and the clinical outcomes of additional LET in non-athletic patients remain less well established. This study aimed to compare short-term postoperative clinical outcomes between isolated hamstring autograft ACLR and ACLR combined with LET in demographically and morphometrically comparable non-athletic patients. Methods: We retrospectively reviewed 83 consecutive non-athletic patients who underwent primary hamstring autograft ACLR between June 2023 and June 2024 with a minimum follow-up of 12 months. Forty-three patients underwent isolated ACLR and 40 underwent ACLR with additional LET. Demographic characteristics, preoperative knee morphometric parameters, and preoperative pivot-shift grades were compared between groups. Postoperative knee stability was assessed using the pivot-shift, Lachman, and anterior drawer tests and KT-1000 arthrometry. Patient-reported outcome measures and postoperative complications were also evaluated. Between-group comparisons were performed using independent-samples t-tests, Mann–Whitney U tests, and chi-square tests, as appropriate. Results: The groups were comparable in demographic characteristics, preoperative morphometric parameters, and preoperative pivot-shift grade distribution (p = 0.558). At final follow-up, a negative pivot-shift test was more frequent in the ACLR + LET group than in the isolated ACLR group (95.0% vs 34.9%; p < 0.001). No significant between-group differences were observed in Lachman testing, anterior drawer testing, or KT-1000 side-to-side differences. KOOS, ACL-RSI, Lysholm, FJS-12, return-to-work time, PASS achievement, and overall complication rates were also comparable between groups. Conclusions: In demographically and morphometrically comparable non-athletic patients with comparable preoperative pivot-shift grade distributions, those who underwent ACLR with additional LET demonstrated a higher rate of negative postoperative pivot-shift testing, whereas anterior stability, patient-reported outcomes, and complication rates were comparable between groups at short-term follow-up. These findings suggest that additional LET was associated with greater postoperative clinical rotational stability in this cohort. Further prospective studies with longer follow-up are warranted.