In the following editorial commentary, the lateral soft tissues responsible for resisting the pivot shift phenomenon with the anterior cruciate ligament (ACL) are considered. The recent history of the anterolateral ligament (ALL) has led to rapid adoption of surgical techniques that have often not been investigated with scientific due process. A step-by-step approach starts with biomechanical testing to establish the anatomy and biomechanical characteristics of soft tissue structures and questions the importance of the ALL and proposes a more important role for the iliotibial band (ITB) passing between attachments to the distal lateral femur and tibia. Subsequent laboratory testing of various operative options shows superiority of lateral extra-articular tenodeses (LETs) as compared with ALL reconstruction.
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