Combined Anterior Cruciate Ligament and Anterolateral Ligament Reconstruction Using Hamstring Autografts: A Detailed...

Persistent rotational instability, reported in 15-35% of isolated anterior cruciate ligament (ACL) reconstruction remains a significant cause of graft failure and impaired return to sports. This has led to an increased interest in supplementing ACL reconstruction with anterolateral ligament (ALL) reconstruction to address residual rotational laxity. ALL reconstruction may better restore rotational stability compared to traditional lateral extra-articular procedures. The patient is positioned supine with the knee flexed at 90°, and standard landmarks are identified. Semitendinosus and gracilis tendons are harvested via a small incision. A quadrupled semitendinosus graft reconstructs the ACL, while the gracilis tendon reconstructs the ALL. Femoral tunnels for ACL and ALL reconstruction share a common anatomical entry point proximal and posterior to the lateral epicondyle. Tibial tunnels for the ALL are created below Gerdy's tubercle. Graft fixation is achieved with a suture disc on both femoral and tibial sides, ensuring physiological tension in extension. Patients begin immediate weight-bearing and range-of-motion exercises within controlled limits. A progressive rehabilitation protocol facilitates return to sports, allowing pivoting activities after six months. Combined ACL and ALL reconstruction using autologous hamstring grafts offers a reproducible surgical option for addressing rotational knee instability. Anatomical graft placement and minimally invasive techniques may offer the potential for improved clinical outcomes, decreased graft failure rates, and enhanced patient return to pre-injury activity levels.