Reverse Passing of Anterior Cruciate Ligament Reconstruction With Simultaneous Anterolateral Ligament Reconstruction...

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Biomechanical Engineering

Background:

• Anterior cruciate ligament (ACL) reconstruction techniques are evolving to improve outcomes, particularly in high-risk populations.
• Rotational control and graft failure remain significant challenges in ACL surgery.

Purpose of the Study:

• To describe a novel inverse ACL reconstruction technique combined with anatomic anterolateral ligament (ALL) reconstruction.
• To detail a surgical method utilizing a retrograde tibial half-tunnel and outside-in femoral drilling for enhanced stability and graft healing.

Main Methods:

• The technique involves an inverse ACL reconstruction with an anatomic ALL reconstruction, using retrograde tibial and outside-in femoral drilling.
• Compatible with hamstring, quadriceps tendon, and bone-patellar tendon-bone autografts, with specific fixation methods described.
• Anatomic ALL reconstruction is achieved by routing the semitendinosus strand or FiberTape reinforcement to Gerdy's tubercle.

Main Results:

• The described technique provides enhanced anteroposterior and rotational stability.
• It promotes improved graft-bone interface healing via circumferential tunnel contact.
• Offers reliable intraoperative visualization of tibial fixation and preserves the iliotibial band.

Conclusions:

• This inverse ACL reconstruction with ALL augmentation offers a versatile and effective solution for improving knee stability.
• The technique is suitable for young athletes, revision cases, and skeletally immature patients, with potential for physeal-sparing applications.