Knee Lateral Extra-articular Tenodesis Procedures: Appropriate Study Design is Essential for Reducing Conflicting Findings and Unnecessary Controversy in the Orthopedic Literature.

Knee lateral extra-articular tenodesis procedures (LEAPS) reduce graft rupture rates when performed at the time of ACL reconstruction. However, in the setting of revision ACL reconstruction, LEAPS is less studied and remains controversial. Many studies support combined procedures (ACL + LEAPS), yet others do not. When the literature comprises small patient cohorts and short follow-up periods, conflicting results often arise. The controversy surrounding may be unnecessarily generated by the publication of low quality studies. Future studies should focus on adequate power, appropriate design and methodology, including matching or randomization to account for potential confounding factors, proper statistical analyses, and avoidance of spin bias.