Combined Anterior Cruciate Ligament Reconstruction With Bone-Patellar Tendon-Bone Autograft and Anatomical Lateral...

Multiligamentous knee injuries involving anterior cruciate ligament rupture and lateral-sided instability, including proximal tibiofibular joint instability and lateral collateral ligament deficiency, present unique challenges in restoring knee stability. This Technical Note describes a reproducible surgical technique for anatomic reconstruction of the anterior cruciate ligament using a bone-patellar tendon-bone autograft and combined lateral collateral ligament and proximal tibiofibular joint reconstruction using a single semitendinosus allograft. Emphasis is placed on proper graft orientation, tunnel placement, and sequential fixation to restore stability in both anterior-posterior and medial-lateral planes of the knee.