Fig 13.

Extra-articular stage and tibial fixation. (A) Passage of Achilles allograft below iliotibial band and to its definitive fixation place in distal tibia. To reinforce the lateral ligament, by use of sutures placed previously, the lateral end of the Achilles graft is slid under the iliotibial band (I) and pulled to its distal fixation point. The iliotibial band is again opened distally (II) to allow graft passage. The distal fixation point is located halfway between the Gerdy tubercle and the head of the fibula. Fixation is performed with a staple while the knee is kept in 30° of flexion and with the foot in a neutral position. (B) Intraoperative clinical image showing traction performed by the surgeon (I) to achieve adequate tension before proceeding to distal fixation (II) of the lateral ligament reinforcement. Traction is performed while the knee is kept close to extension.