Despite advances in anatomic anterior cruciate ligament (ACL) reconstruction, residual rotational instability and recurrent graft failure remain significant clinical challenges in certain patient populations. This review comprehensively evaluates the anatomical, biomechanical, and clinical aspects of anterolateral ligament (ALL) reconstruction and lateral extraarticular tenodesis (LET) procedures in light of current evidence. The anterolateral complex—comprising the ALL, iliotibial band, Kaplan fibers, and anterolateral capsule—plays a critical role in controlling internal tibial rotation, particularly between 30° and 90° of knee flexion. Lateral augmentation procedures are indicated in high-risk patients, including those with high-grade pivot-shift, revision surgery, generalized ligamentous laxity, young athletes, and individuals participating in pivoting sports. Increased posterior tibial slope has emerged as a key anatomical risk factor for graft failure in both primary and revision settings. While ALL reconstruction offers an anatomical approach to restoring anterolateral stability, the modified Lemaire LET technique provides stronger biomechanical rotational control but carries a risk of overconstraint. Both procedures, combined with ACL reconstruction, reduce graft failure rates and improve rotational stability. Questions regarding optimal patient selection, graft tensioning, fixation angle, and long-term outcomes await high-quality prospective studies.