. 2018 Feb 1;7(2):e147–e164. doi: 10.1016/j.eats.2017.08.079

Table 4.

Order of Surgical Steps

1.
Examination under anesthesia.
2.
Lateral dissection, secure common peroneal nerve.
3.
Graft harvesting/preparation.
4.
^∗Diagnostic scope.
5.
^∗Meniscus repair.
6.
^∗Debride ACL and PCL.
7.
^∗Use posterior transseptal portal to check posterior compartments of knee.
8.
^∗Place ACL/PCL pins and confirm positions by C-Arm fluoroscopy.
9.
^∗PCL femoral tunnel drilled.
10.
^∗ACL femoral tunnel drilled.
11.
^∗ACL tibial tunnel drilled.
12.
^∗PCL tibial tunnel drilled.
13.
^∗Pass PCL graft and fix tibial side.
14.
^∗Pass ACL graft and fix femoral side.
15.
Place PLC pins and confirm positions by fluoroscopy.
16.
Pass PLC grafts and secure Müller limb to tibia.
17.
Extend medial dissection and possible repair of MCL.
18.
Place pins in medial side and confirm positions by C-Arm fluoroscopy.
19.
Tension PCL and fix femoral side at 90° of knee flexion.
20.
Tension ACL and fix tibial side at full extension.
21.
Tension and fix PLC on femoral side at 30° of knee flexion with slight valgus.
22.
Tension and fix superficial MCL on tibial and femoral side at 30° of knee flexion with slight varus. (Note if deep MCL or posteromedial corner repair is required by fixation with suture anchors, this should be completed with the knee in full extension prior to addressing the superficial MCL.)

ACL, anterior cruciate ligament; MCL, medial collateral ligament; PCL, posterior cruciate ligament; PLC, posterolateral corner.

^∗

Steps performed under tourniquet.