Anterior Cruciate Ligament Reconstruction and Double Extra-Articular Reinforcement

This study describes a technique for double extra-articular reinforcement associated with anterior cruciate ligament (ACL) reconstruction for patients with both internal and external rotational instability, using reinforcements from the hamstrings and the anterior half of the peroneus longus muscle. The technique involves using 2 reinforcements: one for anterolateral stabilization and the other for anteromedial stabilization. The procedure follows a detailed algorithm for diagnosing rotational instability through physical examination under anesthesia. This approach offers a solution for complex ACL injuries involving bidirectional rotational instability, aiming to optimize knee stability and reduce failure rates in ACL reconstruction.