Combined Intra- and Extra-articular Reconstruction of the Anterior Cruciate Ligament: The Reconstruction of the Knee Anterolateral Ligament

Abstract

We present a new technique for the combined intra-and extra-articular reconstruction of the anterior cruciate ligament. Intra-articular reconstruction is performed in an outside-in manner according to the precepts of the anatomic femoral tunnel technique. Extra-articular reconstruction is performed with the gracilis tendon while respecting the anatomic parameters of the origin and insertion points and the path described for the knee anterolateral ligament.

Combined Anterior Cruciate Ligament and Anterolateral Ligament Reconstruction

“…[9][10][11] Several techniques have been developed to try to anatomically address this structure in the setting of an ACL reconstruction. [12][13][14] The lead author (B.S-C.) has developed a simple anatomic technique to reconstruct the ACL and the ALL of the knee using hamstring tendons and keeping the semitendinosus inserted to preserve tendon vascularization (Video 1, Table 1). …”

The Fascia Lata Anterolateral Tenodesis Technique

“…7 Therefore, techniques have shifted from nonanatomic procedures to procedures attempting to reproduce the anatomy, and techniques for anatomic ALL reconstruction have been proposed using soft-tissue grafts such as gracilis tendon and fascia lata. [18][19][20][21] However, because the ALL is a part of a more complex ligamentous structure (anterolateral complex) involving the whole lateral capsule extending from anterior to posterior, acting along with the ACL in controlling the pivot-shift phenomenon, often injured in the case of acute ACL tears, 22 an anterolateral capsule reinforcement in addition to anatomic ALL reconstruction could be useful with the goal to control rotatory loads.…”

Anterolateral Ligament (ALL) — Myth or Reality?

“…More studies are needed to establish adequate treatment algorithms based on the individual anatomy of the patient. [48][49][50][51] …”