Table 1.

Key Steps, Perils, and Pitfalls in All-Arthroscopic Posterolateral Reconstruction

Portal development	The posterolateral portal should be placed close to the femoral condyle to gain full access to the fibular head. A posterolateral portal positioned too posteriorly may limit the exposure.
Preparation of the PLT and fibular head	Preparation of the fibular head should be performed close to and directly posterior to the popliteus tendon. A more dorsal preparation must be avoided to protect the peroneal nerve and the popliteal nerves and vessels. The peroneal nerve is located 2 to 3 cm distal to the popliteus tendon. Sudden muscle contraction may indicate proximity to the peroneal nerve.
Fibular tunnel placement	For better orientation, the fibular head can be palpated through the skin before the stab incision is created. The direction of tunnel placement should be from anterolateral to posteromedial.
Preparation of the femoral attachments of LCL and PLT	A stay suture may be used to retract the iliotibial band, to provide more space and better visualization, during preparation. During gentle resecting, the lateral joint capsule and the lateral distal femur can be exposed. For better orientation, the femoral footprints of the LCL and PLT can be marked with a radiofrequency electrode (Fig 3B).
Femoral tunnel placement	The drilled LCL tunnel should be sufficiently long to provide space for the tendon graft, and the PLT tunnel should be approximately 3 cm long.
Graft fixation and implantation	For anatomic reconstruction, it is essential to first fix the graft to the femoral PLT footprint. During reconstruction of the PLT, the graft must be shuttled along the course of the native PLT and underneath the native LCL. Fibular graft fixation must be performed before LCL fixation. A nitinol wire is helpful to ensure correct placement of the interference screw in the tunnel (Fig 5B).

LCL, lateral collateral ligament; PLT, popliteus muscle tendon.