Anterior Cruciate Ligament With Anterolateral Ligament Reconstruction Using Hamstring Autograft With Preserved Distal Attachment

Despite advances in surgical techniques for anterior cruciate ligament (ACL) reconstruction, rotational instability has been seen in some patients postoperatively. Recently, authors have reported the anatomic and functional characteristics of the anterolateral ligament (ALL)-a structure that originates near the lateral epicondyle on the femur and inserts on the tibia between the Gerdy tubercle and the fibular head. The ALL is an important stabilizer against anterolateral tibial rotation per recent biomechanical studies, and excellent initial clinical results have been shown with its reconstruction. Several techniques have been developed to try to anatomically address this structure in the setting of ACL reconstruction. This article details a simple anatomic technique to reconstruct the ACL and ALL of the knee using hamstring tendon autograft while retaining the semitendinosus and gracilis insertion on the tibia.