Endoscopic Anterolateral Ligament Reconstruction Using an Iliotibial Band Strip: A Cadaveric Feasibility Study

Area of Science:

• Orthopedic Surgery
• Knee Ligament Reconstruction
• Minimally Invasive Techniques

Background:

• The anterolateral ligament (ALL) plays a crucial role in knee stability, particularly in controlling tibial rotation.
• Current reconstruction methods can involve extensive dissection and may not fully restore native ligament function.
• Kaplan's fibers of the ALL are important for rotational control, and their preservation is a surgical goal.

Purpose of the Study:

• To evaluate the feasibility of a novel, minimally invasive endoscopic technique for anterolateral ligament reconstruction.
• To assess the ability to harvest a fascia lata graft proximally and preserve tibial insertion.
• To determine the accuracy of graft placement using endoscopic and ultrasound guidance.

Main Methods:

• The procedure was performed on eight fresh-frozen cadaveric knees.
• A fascia lata strip was harvested endoscopically proximal to the lateral epicondyle.
• Graft fixation was achieved at the isometric point with ultrasound guidance.
• Post-reconstruction dissection evaluated graft positioning.

Main Results:

• All eight reconstructions were successfully completed with good visualization of the fascia lata.
• The mean graft dimensions were 44.7 mm length and 10.9 mm width.
• Femoral tunnel entry averaged 8.2 mm proximal and 5.2 mm posterior to the lateral epicondyle.
• Adequate release of the deep plane was the primary technical challenge.

Conclusions:

• Endoscopic anterolateral ligament reconstruction using a proximal fascia lata graft is feasible.
• The technique allows for effective graft harvesting and precise placement.
• Preserving a wide tibial insertion may enhance rotational stability of the knee.
• This minimally invasive approach minimizes surgical trauma.