Reconstruction of the Anterior Cruciate Ligament and Anterolateral Ligament Using Internal Brace

The integration of extra-articular procedures in anterior cruciate ligament (ACL) reconstruction is crucial, especially in the context of the high incidence of ACL injuries, which are a leading cause of knee instability and potential progression to post-traumatic osteoarthritis. Injuries to the anterolateral ligament (ALL) and knee capsule are present in nearly 90% of ACL ruptures and are associated with significant rotational instability and grade 3 pivot-shift displacement. This study outlines a technique using the internal brace, a biocompatible device made of ultra-high-molecular-weight polyethylene fibers, not only to augment the ACL reconstruction but also to reinforce the ALL repair. Historically used across various ligament reconstructions, the internal brace aims to enhance postsurgical stability of the knee without increasing morbidity. This approach combines primary ACL reconstruction through arthroscopy with percutaneous reinforcement of the ALL. The method is designed to improve knee function and stability after reconstruction, thereby reducing the risk of ACL rerupture, protecting meniscal repairs, and increasing the rate of return to preinjury athletic performance.