Failure after revision anterior cruciate ligament (ACL) reconstruction may be related not only to graft insufficiency or tunnel-related problems, but also to residual anterolateral rotatory instability. Lateral extra-articular tenodesis (LET), in which an iliotibial band graft is passed deep to the lateral collateral ligament and fixed to the distal femur, is an extraarticular augmentation procedure designed to improve anterolateral rotatory control. In revision ACL surgery, the main goals of LET are to reduce the pivot shift, limit internal tibial rotation, and share load with the ACL graft. The most appropriate candidates are young, highly active patients with high-grade pivot shift, a marked side-to-side difference in anterior tibial translation, generalized ligamentous laxity, or knee hyperextension. During surgical planning, previous femoral tunnels, the planned graft trajectory, and the LET fixation point should be evaluated together. However, LET should not be considered a salvage procedure for malpositioned tunnels, inappropriate graft selection, malalignment, meniscal deficiency, or untreated associated ligament pathology. This review summarizes the anatomic and biomechanical rationale, indications, modified Lemaire technique, clinical outcomes, and principles for avoiding technical errors in LET during revision ACL reconstruction.