09/09/2026
Lateral Procedures in ACL Reconstruction
Few procedures in sports knee surgery have undergone a revival as striking as lateral extra-articular procedures (LEAP). In 1989, LEAP were abandoned in the United States, following an American Orthopaedic Society for Sports Medicine (AOSSM) consensus that questioned their clinical benefit and amid concerns regarding post-operative stiffness, over-constraint and lateral compartment osteoarthritis. 11 More recently, however, LEAP has re-emerged as an effective adjunct to anterior cruciate ligament reconstruction (ACLR). What was once reserved for selected “high-risk patients” is increasingly being added to both primary and revision ACLR across a widening range of indications in an attempt toto reduce graft failure.
However, the scientific question we are asking has changed; We no longer wish to know if a LEAP is effective. Instead, we want to know who needs it and, increasingly, who does not?
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