Table 1.

Advantages, Indications, Contraindications, Tips and Pearls, and Pitfalls and Risks of Combined Anterior Cruciate Ligament and Anterolateral Ligament Reconstruction

Advantage

Provides anatomic reconstruction of ACL and ALL

Indication

Cases with higher grades on the preoperative pivot-shift test and reconstruction revision cases, especially those without an apparent cause of failure

Contraindications

Autologous grafts of insufficient size (unless one can use tissue bank grafts)

Performance of our technique without treatment of known causes of ACL failure in revision cases

Tips and pearls

Measure the lengths of grafts right after harvesting them.

Open the iliotibial tract toward its fibers on the lateral access route.

Find the correct radiographic landmark to insert the femoral anchor.

Note that anatomically locating the tibial landmark for ALL reconstruction is easier between the Gerdy tubercle and fibular head.

Avoid leaving the anchor protruding both on the femur and on the tibia.

Pass the ALL graft under the iliotibial band to fix it on the tibia.

Pitfalls and risks

Protruded anchors can irritate the iliotibial band.

An absolute lateral view must be obtained to find the correct femoral radiographic landmarks; small inaccuracies can lead to totally incorrect points.

When preparing the femoral tunnel for the ACL, care should be taken not to interfere with the anchor already placed on the femur for the ALL reconstruction.

Patients can have lateral discomfort because of the iliotibial tract incision for up to 6 weeks.

ACL, anterior cruciate ligament; ALL, anterolateral ligament.