Combined Double Bundle Anterior Cruciate Ligament Reconstruction and Anterolateral Ligament Reconstruction

A double-bundle anterior cruciate ligament (ACL) reconstruction associated with an anterolateral ligament (ALL) reconstructions is performed. The semitendinosus and gracilis are harvested. At knee maximum flexion, the anteromedial (AM) femoral tunnel is performed in the AM footprint area. Through the anterolateral portal, the tip of the outside-in femoral guide is placed in the posterolateral footprint area. The guide sleeve is pushed onto the lateral femoral cortex at the ALL attachment. At 110° knee flexion, the posterolateral-ALL tunnel is performed. The tibial ACL tunnel is performed as usual. The tibial guide is placed between the ALL tibial attachment and the tibial ACL tunnel entrance to perform the ALL tibial tunnel. The gracilis graft is introduced from caudal to cranial, achieving fixation with a 6-mm diameter screw (outside-in). The AM femoral fixation is achieved with a suspension device. ACL tibial graft fixation is achieved with a screw. Afterward, the gracilis is passed under the fascia lata to the tibial entry point. A 6-mm diameter screw is placed from the external cortex into the tibial ALL tunnel. The biomechanical advantage of the double-bundle ACL reconstruction with the biomechanical advantage of the ALL anatomic reconstruction is achieved.