188 young patients (<25yo) scheduled for ACL reconstruction were randomized to undergo the procedure with or without the addition of lateral extra-articular tenodesis. Patients were assessed at 6- and 12-month follow-up for limb symmetry index (LSI) (discrepancy between operated and contralateral limbs) in hop test functional performance, measures of quadriceps strength, measures of hamstring strength, patient-reported function, and pain. Results demonstrated significantly lower LSI for hop tests, quadriceps torque and power, and patient-reported function at 6 months in those who received lateral extra-articular tenodesis compared to those who did not. By 12 months, LSI outcomes, quadriceps torque, and patient-reported function were no longer significantly lower in the ACLR+LET group; and quadriceps power was actually significantly higher in the ACLR+LET group at 12 months.