Table 2.

Advantages, Risks, and Limitations of Minimally Invasive ALL Reconstruction Technique

Advantages

Easy and reproducible technique

Anatomic reconstruction that mimics the native fan-shaped ALL, having a single femoral and broad-based tibial attachment

Avoidance of the complications associated with an EAT, such as stiffness and alteration of knee joint biomechanics, in a grossly unstable knee

Cosmetic scar

Risks and limitations

Improper tunnel placement can occur because of the nature of the technique. We, therefore, recommend a larger incision at the beginning of the learning curve or when in doubt about the guidewire placement.

The critical point is the femoral placement, which should be proximal and posterior to the lateral epicondyle. Errors in femoral socket placement will result in a non-isometric reconstruction.

Improper femoral placement may lead to loss of flexion due to an overly tight ALL.

Care must be taken to ensure that the ALL graft passes under the ITB.

ALL, anterolateral ligament; EAT, extra articular tenodesis; ITB, iliotibial band.