Anterior cruciate ligament reconstruction (ACLR) is commonly performed in the younger or active population, but failure rates have been disappointing in high-risk patients. Recently, lateral extra-articular procedures such as the modified Lemaire extra-articular tenodesis (LET) have been proposed to decrease failure rates, but knowledge on short-term rehabilitation, stiffness, and isokinetic strength is limited. This study aimed to assess the short-term patient-reported outcome measures (PROMs) and physical performance outcomes following ACLR with and without LET. A prospective study was performed among 152 patients aged ≤25 years undergoing hamstring autograft ACLR with or without modified Lemaire LET between 2019 and 2022 with minimum 1-year follow-up. PROMs (Tegner, International Knee Documentation Committee, Lysholm, NRS for pain, and EQ-5D) were compared between groups preoperatively and at 3, 6, 9, 12, and 24 months, while physical performance (range of motion [ROM], and limb symmetry indices [LSI] of isokinetic testing, single-leg and timed-6m hop) was compared up to 9 months postoperatively. Baseline characteristics and outcomes were similar, except thicker grafts in the LET group (8.9 vs. 8.7 mm, p = 0.047). At 3 months, Lemaire patients reported less pain (NRS pain 17.1 vs. 35.6, p < .001), but at 6 months, Lemaire patients had inferior LSI for timed-6m hop (87% vs. 96%, p = 0.003). At 9 months, Lemaire patients had similar return to sports, PROMs, and ROM, but had lower LSI for flexion endurance strength (88% vs. 97%, p = 0.041). At 12 months, no differences were seen in PROMs. In conclusion, Patients undergoing ACLR with LET had less pain at 3 months, but worse LSI for timed-6m hop at 6 months and worse LSI for flexion endurance strength at 9 months. Both groups showed similar performance on all other outcomes, indicating that ACLR with LET is not associated with increased stiffness, complications, or significant strength deficits.

Level of evidence: Level II prospective study.

This study was performed at: Centre for Orthopaedic Research Alkmaar (CORAL) and the Department of Orthopaedic Surgery, Northwest Clinics, Alkmaar, The Netherlands.

Received: 18 March 2025

Accepted: 26 September 2025

Accepted Manuscript online:
29 September 2025

Article published online:
14 October 2025

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