Approach to Residual Anterolateral Rotatory Knee Instability After Anterior Cruciate Ligament Reconstruction

» Arthroscopic anterior cruciate ligament (ACL) reconstruction is widely regarded for its excellent results in restoring tibiofemoral anterior laxity to near-normal levels.» However, some operated patients may still experience anterolateral rotatory instability, leading to dissatisfaction and feelings of instability. After ruling out injuries to the posteromedial corner, lateral collateral ligament, and posterolateral corner, the focus should shift to the anterolateral ligament (ALL) and Kaplan fibers.» For ALL injuries causing internal rotatory instability at around 30 degrees knee flexion, a modified deep Lemaire tenodesis is recommended.» Kaplan fiber injuries leading to internal rotatory instability at angles greater than 30 degrees knee flexion can be treated with a modified superficial Lemaire surgery and iliotibial band strap fixation in the distal Kaplan fiber anatomical position.