Contraindications to Lateral Extra-Articular Tenodesis: A Systematic Review

Background: Lateral extra-articular tenodesis (LET) is a surgical procedure that is additionally implemented in concurrent anterior cruciate ligament reconstruction (ACLR). Although numerous articles have addressed the use of LET in conjunction with ACLR, few definitive contraindications were identified. Given the scarcity of literature evaluating contraindications for LET modality, this study aimed to systematically review the reported contraindications of this procedure in the context of concurrent ACLR. Methods: The searched key terms: (extra-articular OR extraarticular) AND (tenodesis OR plasty OR augmentation OR procedure or reconstruction OR reconstructive OR surgical OR surgery OR technique) AND (ACL OR anterior cruciate ligament), with no publication date restrictions in PubMed, ScienceDirect, Cochrane Central, Web of Science, and Embase databases. We included clinical human studies, with levels of evidence I-III and in the English language. Results: The analysis evaluated fourteen articles published between 2012 and 2024. Level III evidence was found in the majority of studies (n = 9) and Level I evidence was found in the rest (n = 5). The majority of the included articles were retrospective (n = 8) and there were also prospective studies (n = 6). The articles reviewed showed that articular cartilage damage and concomitant injuries to other knee ligaments, alongside ACL injury, are the most frequently mentioned. Conclusions: This is the first study that systematized the contraindications for the LET procedure in ACLR. The contraindications remain unclear; however, the following may be highlighted: articular cartilage damage and injury to another ligament in the knee, in addition to ACL injury.