Residual rotational instability following anterior cruciate ligament (ACL) reconstruction remains a major concern in highdemand athletes and is associated with increased graft failure and compromised functional outcomes. The anterolateral structures of the knee -particularly the anterolateral ligament (ALL) and the iliotibial band complex- play a key role in controlling tibial internal rotation. Recent biomechanical and clinical evidence suggests that lateral augmentation procedures, including lateral extra-articular tenodesis (LET) and ALL reconstruction (ALLR), enhance rotational stability, reduce graft loading, and lower revision rates when combined with primary ACL reconstruction. This review provides a comprehensive evaluation of the anatomical basis, indications, surgical nuances, and clinical outcomes of lateral augmentation techniques performed in conjunction with ACL reconstruction in athletic populations.