Combined Revision of Anterior Cruciate Ligament and Lateral Extra-Articular Procedure Using Rectus Femoris Autologous...

Revision of combined anterior cruciate ligament (ACL) reconstruction (ACLR) and lateral extra-articular procedure (LEAP) presents many challenges that are not encountered in the primary setting or when an isolated ACLR revision is performed. In recent years, there has been a significant increase in the number of primary ACLRs combined with LEAP, supported by growing literature on the anterolateral ligament and its role in rotational stability of the knee. Although the graft rupture rate is decreased with combined ACLR + LEAP, whenever this event occurs, it presents significant difficulties in managing the revision of both ACLR and LEAP. This paper presents a surgical technique to address failure of both ACL and anterolateral ligament reconstruction, using the superficial layer of the quadriceps tendon graft. This technique offers several advantages, including no need for allograft, low donor-site morbidity, predictable graft size and length, and the absence of any need for specific instruments.