Pedicled Anterior Cruciate Ligament Reconstruction and Lateral Extra-articular Tenodesis Without Additional...

Despite constant development of surgical techniques, the outcomes of anterior cruciate ligament (ACL) reconstructions remain unpredictable, and the failure rate remains unacceptably high. Among many factors influencing results, the graft-healing process called ligamentization has recently been highly emphasized. Improvement of healing potential, connected with graft diameter optimization and the addition of lateral extra-articular tenodesis, might lead to superior treatment results. We describe a simple technique of combined anterior cruciate ligament reconstruction with a pedicled hamstring graft of case-specific diameter and lateral extra-articular tenodesis with limited hardware. "PARLET" stands for pedicled anterior cruciate ligament reconstruction and lateral extra-articular tenodesis without additional implants. Three options of graft preparation (3, 4, or 6 strands) enable diameter versatility and optimization during surgery. Preserving the hamstring pedicle and limiting its interference with tibial fixation due to the use of an ACL adjustable cortical button might improve graft healing potential. Fixation of lateral tenodesis with a femoral ACL cortical button solves the problem of tunnel or implant interference.