What question did this study set out to answer?

This study aims to compare functional and clinical outcomes of BPTB ACL reconstruction with and without lateral extra-articular tenodesis in amateur soccer players.

July 8, 2026

Lateral Extra-articular Tenodesis Was Not Associated With Improved Mid-term Outcomes After Primary BPTB ACL Reconstruction in Amateur Soccer Players: A Prospective Comparative Cohort Study

Key Points

This study aims to compare functional and clinical outcomes of BPTB ACL reconstruction with and without lateral extra-articular tenodesis in amateur soccer players.
Prospective, nonrandomized cohort study with 165 enrolled athletes (150 completed follow-up) from 2017-2020.
Participants underwent either isolated BPTB ACLR or BPTB ACLR with LET using modified Lemaire technique.
Primary outcomes included IKDC, Lysholm, Tegner scores, graft failure, and reoperations.
Both groups experienced significant improvement in PROMs (p < .001) with no significant differences in IKDC (mean difference 2.4, p = .14) or Lysholm scores (2.9, p = .07).
Graft failure rates were similar at 5.3% for isolated BPTB versus 4.1% for BPTB+LET (p = .72).
Return to competitive soccer was achieved by 82.4% and 80.2% of athletes in the BPTB and BPTB+LET groups, respectively.

Abstract

Purpose: To compare clinical and functional outcomes in competitive amateur soccer players undergoing isolated bone–patellar tendon–bone (BPTB) anterior cruciate ligament reconstruction (ACLR) versus BPTB ACLR combined with lateral extra-articular tenodesis (LET) using a modified Lemaire technique. Methods: In this prospective, nonrandomized comparative cohort study, 165 athletes treated between 2017 and 2020 were enrolled, 150 (91%) completed minimum 5-year follow-up. Surgical technique was selected according to the surgeon’s evolving practice. Seventy-four underwent isolated BPTB ACLR and 76 underwent BPTB ACLR + LET. Primary outcomes were IKDC, Lysholm, Tegner, graft failure (rerupture or symptomatic objective instability), and reoperations. Secondary outcomes were stability, return to sport (RTS), radiographic osteoarthritis, and range of motion. IKDC MCID/PASS and Lysholm PASS (≥85 points) were recorded. Results: Both groups showed significant improvements in PROMs from baseline (p < .001). At final follow-up, no between-group differences were found for IKDC (mean difference, 2.4; p = .14), Lysholm score (2.9; p = .07), or Tegner activity level (0.5; p = .11). IKDC MCID and PASS rates were similarly high between groups (88.5% vs 90.1% and 84.2% vs 86.0%, respectively), as were Lysholm PASS rates (67.6% vs 80.3%). Graft failure rates were low and comparable (5.3% vs 4.1%; p = .72), as were reoperation rates (9.4% vs 10.5%; p = .81). Knee stability improved in both groups, with comparable final side-to-side differences of approximately 2 mm. Return to competitive amateur soccer was achieved by 82.4% of patients in the BPTB group and 80.2% in the BPTB+LET group. Radiographic osteoarthritis was observed in 17.1% and 25.8% of patients (p = .24). Conclusions: In competitive amateur soccer players, adding LET to primary BPTB ACLR was not associated with superior PROMs, knee stability, or RTS at mid-term follow-up. Both procedures showed similarly low graft-failure and reoperation rates and comparable functional recovery. Level of Evidence: II, Nonrandomized comparative study.

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