Fig 10.

Multiligament reconstruction in a left knee. After drilling the intra-articular tunnels, the anterior cruciate ligament (ACL) graft is the first to be secured in the femur, followed by the posterior cruciate ligament (PCL) grafts. Attention is then turned to the PCL grafts fixation in the tibia, which are secured using screws and a spike washer. The anterolateral bundle graft is fixed to the tibia with the knee flexed to 90° and in neutral rotation while applying the anterior force. Then, the knee is placed in full extension and the posterior medial bundle graft is fixed, while distal traction is applied to the graft.