189: LEAP Forward: The Evolution of ACL Management with Dr. Bonnie Gregory & Dr. Henry Ellis - Live at AOSSM 2026

Lateral extra-articular procedures (LEAPs) have evolved from a controversial adjunct to ACL reconstruction into an increasingly evidence-supported tool for managing rotational instability and reducing graft failure in appropriately selected patients.In this episode of The Sports Docs Podcast, Drs. Henry Ellis and Bonnie Gregory join us live from the AOSSM Annual Meeting to discuss where lateral augmentation fits in modern ACL management. They explore the evidence behind lateral extra-articular tenodesis (LET), patient selection and indications, potential complications, LET versus anterolateral ligament reconstruction (ALLR), surgical technique, fixation strategies, and rehabilitation considerations.The conversation also highlights the Arthrex Knee FiberTak system, including how an all-suture anchor platform may address some of the limitations of traditional LET fixation.Key Topics DiscussedWhy add a lateral augmentation procedure to ACL reconstruction?Evidence demonstrating reduced ACL graft rupture and improved rotational stabilityThe role of LEAP in high-risk primary ACL reconstruction and revision ACL surgeryImpact on return to sport and pre-injury level of playEmerging evidence supporting the cost-effectiveness of LETUnderstanding the potential downsidesLateral-sided pain and hardware irritationHematoma and need for hardware removalEarly quadriceps weaknessConcerns regarding over-constraint and long-term degenerative changesWhether adding a lateral procedure meaningfully changes postoperative recoveryWho actually needs a LEAP?Young, active athletesHigh-grade pivot shift or anterior laxityKnee hyperextensionRevision ACL reconstructionAthletes returning to pivoting sportsHamstring autograft ACL reconstructionMultiple coexisting risk factorsChronic ACL deficiency and other emerging indicationsLEAP in elite athletesHow professional team physicians are approaching lateral augmentationCurrent practice patterns in elite and professional sportsThe balance between maximizing graft survivorship and avoiding unnecessary proceduresLET versus ALL reconstructionDifferences in surgical approachClinical outcomes and graft failureRotational stabilityOperative time, cost, and potential complicationsWhy surgeons may favor one technique over the otherModern LET surgical techniqueGraft harvest and preparationRelationship of the graft to the LCLFemoral fixationKnee position during fixationGraft orientation and isometryAvoiding over-constraintImportance of anatomic attachment sitesManagement of the IT band at the conclusion of the procedureSpotlight: Arthrex Knee FiberTakThe episode takes a closer look at the Knee FiberTak platform and its application in lateral augmentation.The guests discuss how an all-suture anchor platform may offer advantages compared with traditional fixation methods, including:Reduced hardware prominenceBone preservationPotentially decreased risk of tunnel convergenceLow-profile fixationErgonomic instrumentation designed specifically for the kneeMultiple fixation configurations for different surgical applicationsThe Knee FiberTak family includes:Double-Knotless AnchorDouble-Knotted AnchorHybrid AnchorInternalBrace AnchorKnee FiberTak ButtonThe discussion explores how surgeons select between different configurations and how a versatile fixation platform can improve efficiency and adaptability in the operating room.Rehab & Return to SportThe episode concludes with a practical discussion of rehabilitation following ACL reconstruction with lateral augmentation.While the addition of a LEAP generally does not dramatically alter standard postoperative restrictions, the guests emphasize several priorities:Regaining full knee extensionRestoring quadriceps strength and activationMonitoring early quadriceps recoveryMaintaining appropriate progression through rehabilitationPreparing the athlete for a safe and successful return to sportSummaryLEAPs are no longer simply a historical technique being revisited. Contemporary evidence suggests that appropriately selected patients—particularly young, high-risk athletes, patients with significant rotational instability, revision ACL cases, and athletes returning to pivoting sports—may benefit from lateral augmentation as part of a comprehensive ACL reconstruction strategy.The challenge for modern sports surgeons is determining who truly benefits, which technique is most appropriate, and how to perform the procedure without introducing unnecessary morbidity or over-constraint.DisclaimerThis episode is sponsored by Arthrex. The discussion includes Arthrex products, including the Knee FiberTak system. The views and opinions expressed by the guests are their own and are intended for educational purposes.