Enhancing ACL Reconstruction: The Role of Lateral Extra-Articular Tenodesis in Professional Rugby

What is an ACL injury?

The Anterior Cruciate Ligament (ACL) is an important ligament within the knee joint responsible for stability. The ACL connects the tibia (shin bone) and the femur (thigh bone) and prevents the tibia from moving forwards too much and helps with rotational stability.

An injury to the ACL could either be a partial strain or a complete rupture but review with a surgeon will be necessary to determine management. An injury to the ACL can only be diagnosed via an MRI scan however here at Pro Sports medicine we can take a thorough history and assess your knee subsequently referring you on to the correct medical professionals.

Statistics

The ACL is the most commonly injured ligament in the athletic knee. Women are 4-6 x more likely to sustain an ACL injury in comparison to their male counterparts. 80% of ACL injuries are non-contact and often happen during sharp deceleration and/or change of direction. The greatest risk ages for women are 15-25 years.

Surgery vs conservative management

ACL injuries should be managed through an individualised approach, and this can be discussed with the team at Pro Sports Medicine.

Anterior Cruciate Ligament (ACL) injuries are a significant concern in professional sports, particularly in high-impact games like rugby. The quest for surgical techniques that not only facilitate a swift return to play (RTP) but also extend athletes’ careers is ongoing. Recent research highlights the potential benefits of incorporating Lateral Extra-Articular Tenodesis (LET) into primary ACL reconstruction (ACL-R) for professional rugby players.

Understanding ACL Injuries and Reconstruction

The ACL is crucial for knee stability, and its injury can sideline athletes for extended periods. Traditional ACL-R aims to restore knee function and enable RTP. However, concerns about re-injury and long-term joint health have led surgeons to explore adjunct procedures like LET.

What is Lateral Extra-Articular Tenodesis?

LET is a surgical procedure that involves reinforcing the lateral aspect of the knee to limit rotational instability. By adding LET to ACL-R, surgeons aim to reduce the strain on the ACL graft, potentially decreasing the risk of re-injury.

Recent Findings on LET in Professional Rugby Players

A study published in Knee Surgery, Sports Traumatology, Arthroscopy (April 2025) by Borque et al. examined the impact of LET combined with ACL-R on career longevity in professional rugby players. The retrospective review included 118 athletes who underwent primary ACL-R between 2005 and 2019. Key findings include:

High RTP Rates: 92% of athletes returned to professional rugby at an average of 9.6 months post-surgery.
Extended Career Length: Players who underwent ACL-R with concomitant LET had an 18% greater chance of continuing their professional careers five years post-surgery compared to those who had ACL-R alone.
Influence of Age: Younger athletes demonstrated a longer career span post-surgery.

These results suggest that adding LET to ACL-R may enhance knee stability, reduce re-injury rates, and contribute to prolonged athletic careers in high-demand sports like rugby.PubMed

Implications for Rehabilitation

Integrating LET into ACL-R has implications for postoperative rehabilitation:

Customised Rehab Protocols: Rehabilitation should address the specific biomechanics of LET, focusing on restoring strength and flexibility while protecting the reconstructed structures.
Gradual Progression: A carefully monitored progression back to sport-specific activities is essential to ensure the knee’s stability and functionality.
Close Monitoring: Regular assessments can help detect any issues early, allowing for timely interventions and adjustments to the rehabilitation plan.

Rehabilitation- what does this look like?

Rehabilitation takes on an individualised approach and together with the physiotherapists at Pro Sports Medicine you can discuss your goals and what activities you want to return to.

Rehabilitation post ACL injury requires dedication to allow for the return of functional range of movement in the knee, muscle strength, power, function and return to sport. Depending on your goal the physiotherapists will work together with you to tailor your plan.

Return to sport

Return to sport and performance requires a battery of testing to be undertaken to ensure that you are ready to return, and your risk of re-injury or subsequent injury is mitigated.

Here at Pro Sports medicine, we have the expert clinicians and equipment to ensure that we have you covered through the use of VALD force plate technology and our Alter-G anti-gravity treadmill.

Conclusion

The integration of LET into primary ACL reconstruction presents a promising avenue for enhancing career longevity in professional rugby players. By improving knee stability and potentially reducing re-injury rates, this combined approach offers a strategic advantage in the management of ACL injuries. As always, individualised treatment plans and rehabilitation protocols remain crucial to optimise outcomes for each athlete.

Should you require any further information about how the team at Pro Sports Medicine can support your ACL rehab – please complete the below contact form;