Arthroscopy Techniques (Apr 2017)

Combined All-Inside Anterior Cruciate Ligament Reconstruction and Minimally Invasive Posterolateral Corner Reconstruction Using Ipsilateral Semitendinosus and Gracilis Autograft

  • Zakk M. Borton, B.M.B.S., B.Med.Sci.(Hons.),
  • Sam K. Yasen, M.B.B.S., B.Sc.(Hons.), M.Sc.(Eng.), F.R.C.S. Tr. & Orth., Dip. S.E.M.,
  • Edward M. Britton, M.B.B.S., B.Sc., F.R.C.S. Tr. & Orth.,
  • Samuel R. Heaton, M.B.B.S., B.Sc.(Hons.), M.Sc.(Eng.), F.R.C.S. Tr. & Orth.,
  • Harry C. Palmer, M.Sc., L.L.B.(Law),
  • Adrian J. Wilson, M.B.B.S., B.Sc.(Hons.), F.R.C.S. Tr. & Orth.

Journal volume & issue
Vol. 6, no. 2
pp. e331 – e339

Abstract

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The anterior cruciate ligament (ACL) is the most commonly injured knee ligament, particularly among adolescents and young adults. Unrecognized posterolateral laxity is understood as a major cause of ACL reconstruction failure, and concomitant injury to the posterolateral corner (PLC) is prevalent and underdetected. We advocate screening all ACL-deficient knees for PLC injury and present a technique combining minimally invasive PLC reconstruction with anatomic all-inside ACL reconstruction. The combined procedure uses only the ipsilateral hamstring tendons representing a major surgical advantage over traditional management approaches. The semitendinosus is quadrupled and attached to 2 adjustable suspensory cortical fixation devices to form the ACL graft. The gracilis tendon is looped through the fibula head and secured in a single femoral tunnel for the PLC reconstruction via 2 minimally invasive incisions. The use of a single femoral PLC tunnel combined with a single femoral ACL socket minimizes the risk of tunnel convergence.