Trends in lateral extra-articular augmentation use and surgical technique with anterior cruciate ligament reconstruction from 2016-2023, an ACL Study Group Survey.

Purpose: To survey the ACL study group (ACLSG) members to determine the current practice patterns surrounding the use and methodology of lateral extra-articular procedures (LEAPs), including anterolateral ligament reconstruction (ALLR) or lateral extra-articular tenodesis (LET) during ACL reconstruction (ACLR).
Methods: A web-based questionnaire was distributed to members of the ACLSG during the 2016, 2018, 2020, and 2023 biennial meetings. Questions explored the indications and techniques when incorporating LEAPs in ACLR.
Results: Analysis of survey responses found that the reported use of LEAPs in both primary and revision ACLR significantly increased between 2016 and 2023 and that surgeons were using lateral augmentation more frequently over time. Surgical techniques were stable across survey years, with most surgeons using iliotibial band (ITB) autograft attached at Gerdy's tubercle, passed under the lateral collateral ligament (LCL), and anchored proximal/posterior to the lateral femoral epicondyle.
Conclusion: Survey responses demonstrate that LEAPs are becoming more common among ACL surgeons in the ACL SG, with the modified Lemaire LET being the predominant technique. This aligns with recent clinical studies showing improved outcomes and reduced risk of failure in ACLR with lateral augmentation compared to ACLR alone.
Level of Evidence: Level V, Expert Opinion.
Competing Interests: Declaration of Competing Interest P.A.S. reports board or committee membership in the Arthroscopy Association of North America, as well as editorial or governing board membership of Journal of Knee Surgery. He is a consultant for Arthrex, and also receives speaker’s fees, royalties and research support from Arthrex. He is s stockholder in Spinal Simplicity. V.M. reports a relationship with Smith and Nephew Inc including consulting or advisory, funding grants, and speaking and lecture fees, funding grants from Arthrex, a relationship with International Society of Arthroscopy Knee Surgery and Orthopaedic Sports Medicine that includes board membership, consulting for Newclip consulting, and a shareholder of Ostesys. P.C.M.V. receives royalties from ConMed. B.S.-C. has received consulting fees and royalties from Arthrex and stock options held in AREAS. A.G. receives grant support from Canadian Institutes of Health Research, National Institutes of Health, Canadian Foundation for Innovation, Ontario Research Fund, Smith & Nephew, and Ossur, outside the submitted work; receives personal fees from Smith & Nephew; is on the advisory board of Spring Loaded Technologies; and owns stock in Precision OS, LinkX Robotics, and Ostesys Robotics. S.L.S. reports consultant fees from Arthrex, other from BioVentus, other from CONMEDLinvatec, JRFOrtho, other from Kinamed, Smith & Nephew, and Vericel; speaking fees from Arthrex, CONMEDLinvatec, Joint Restoration Foundation, Kinamed, Smith & Nephew, and Vericel; stock/stock options held in Epic Bio, Reparel, Sarcio, and Vivorte; and royalties from CONMEDLinvateco.
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