Posterolateral sling reconstruction of the popliteus tendon: an all-arthroscopic technique

Injuries to the posterolateral corner of the knee present with variable injury patterns that have produced a number of reconstructive procedures in the literature. We present an all-arthroscopic technique that reconstructs the popliteus tendon using either a semitendinosus autograft or an anterior tibialis allograft. After exposure of the posterior tibia by use of the posteromedial and trans-septal portals for visualization and posterolateral portal as a working portal, the popliteus musculotendinous junction is identified. In preparation for tibial tunnel drilling, a Kirschner wire is passed from the Gerdy tubercle to the popliteus musculotendinous junction on the posterior tibia, which is localized by use of an anterior cruciate ligament tibial tunnel guide brought in through the posterolateral portal. The 6-mm tibial tunnel is then created. The femoral insertion site is identified by use of the anterolateral portals for visualization and by use of the accessory superolateral portal for debriding the synovial fold at the insertion of the popliteus tendon. A K-wire is inserted, and a socket is established. The selected graft is then implanted by passing the graft through the tibial tunnel from anterior to posterior with a passing suture and pulling it up anteriorly and superiorly to the femoral socket. The graft is tensioned with the knee in 90 degrees of flexion and in neutral rotation before fixation of both ends of the graft with bio-interference screws.