Abstract Purpose Increased tibiofemoral (TF) rotation has been linked to a higher risk of graft failure following anterior cruciate ligament reconstruction (ACLR). This study evaluated whether isolated ACLR or the addition of lateral extra‐articular tenodesis (LET) influences TF rotation in professional soccer players. Methods A retrospective review was conducted on professional soccer players who underwent ACLR between January 2012 and August 2024. Inclusion criteria were primary ACL injury and availability of pre‐ and postoperative magnetic resonance imaging (MRI). Players were grouped based on whether LET was performed in addition to ACLR, thus forming two groups who either underwent ACLR or ACLR + LET. Demographic and anatomical variables, including age, medial and lateral posterior tibial slope (PTS), knee flexion during MRI, tibial tubercle–trochlear groove (TTTG) distance, and TF rotation, were compared. A subgroup analysis was performed in players with available pre‐injury MRI, allowing assessment across three time points: pre‐injury, preoperative, and postoperative. Statistical analyses included appropriate parametric and nonparametric tests for group comparisons, repeated measures, and reliability assessment, with significance set at p 0.05). Across all players, TF axial rotation did not change significantly from pre‐ to postoperative imaging (6.3 ± 6.0° vs. 6.3 ± 5.8°, p = 0.876). TTTG distance increased from 8.7 mm to 9.4 mm ( p = 0.026), and knees were slightly more extended postoperatively (18.2° ± 5.8 vs. 16.4° ± 6.1, p = 0.006). No significant differences in delta values for knee flexion, TTTG, or TF rotation were observed between ACLR and ACLR + LET groups (all p > 0.05). In 16 players with MRI at all three time points, no significant changes in TTTG or TF rotation occurred (both p > 0.05). Conclusion Resting TF rotation remained unchanged after ACLR, regardless of LET augmentation, suggesting LET does not modify baseline rotational alignment in professional soccer players. Level of Evidence Level III, retrospective comparative study.
Ackermann et al. (Wed,) studied this question.