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. In this prospective, nonrandomized comparative cohort study, 165 athletes treated between 2017 and 2020 were enrolled; 150 (91%) completed a 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 International Knee Documentation Committee (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 minimal clinically important difference (MCID)/ patient acceptable symptom state (PASS) and Lysholm PASS (≥85 points) were recorded. Both groups showed significant improvements in patient-reported outcome measures (PROMs) from baseline (p < 0.001). At final follow-up, no between-group differences were found for IKDC (mean difference, 2.4; p = 0.14), Lysholm score (2.9; p = 0.07), or Tegner activity level (0.5; p = 0.11). 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 = 0.72), as were reoperation rates (9.4% vs. 10.5%; p = 0.81). 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 = 0.24). 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. The study provides level II evidence, a nonrandomized comparative study.

Received: 17 March 2026

Accepted after revision: 03 July 2026

Accepted Manuscript online:
06 July 2026

Article published online:
15 July 2026

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