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

Introduction This study introduces an innovative, minimally invasive technique for reconstructing the anterolateral ligament of the knee. The approach involves harvesting a fascia lata band strip proximally to the lateral epicondyle (LE), thereby avoiding distal dissection. This method may replicate the function of Kaplan's fibers by preserving a broad tibial insertion, potentially improving tibial rotational control. The aim of the study was to evaluate the feasibility of this technique under endoscopic guidance. Materials and methods The procedure was carried out on eight fresh-frozen cadaveric knees. The fascia lata strip was harvested endoscopically and fixed at the isometric point with the assistance of ultrasound guidance. Following the reconstruction, each knee was dissected to assess graft positioning. Results All eight procedures were successfully completed. Visualization of the fascia lata was consistently good throughout. The primary technical challenge was achieving adequate release of the deep plane, which was occasionally hindered by tissue adhesions. The harvested strips had a mean length of 44.7 mm (range: 38-51 mm) and a mean width of 10.9 mm (range: 9-13 mm). The femoral tunnel entry point was located an average of 8.2 mm (range: 7-10 mm) proximal and 5.2 mm (range: 4-6 mm) posterior to the LE. Conclusions This minimally invasive technique appears feasible under endoscopic guidance, enabling effective graft harvesting and precise positioning. By preserving a wide tibial insertion, the approach may enhance rotational control of the knee while minimizing surgical trauma.