Table 3.

Advantages and Limitations of Technique

Advantages

The surgeon can choose the orientation of the new tunnels without restrictions.

The substrate for osseointegration of the reconstruction is optimal.

The use of an Achilles graft makes it possible to replace the absent autologous graft.

The use of an Achilles graft allows reconstruction of both the ACL and ALL.

Donor-area morbidity is reduced.

The bone block of the Achilles graft allows a natural fixation without using implants.

Rotational stability is increased thanks to lateral ligament reinforcement.

The iliotibial band is not weakened by other anterolateral techniques.

The possibility of convergence of the ACL and anterolateral tunnels is avoided.

A longitudinal incision in the lateral aspect of the knee is not necessary for lateral reinforcement.

The ischemia time is shorter if the Achilles graft is prepared before tourniquet application.

Limitations

Two surgical procedures, which multiplies associated risks

Longer modification time of normal activity, during integration of tunnel filling

More time with unstable knee, which increases risks of meniscal and/or chondral damage

Higher rerupture risk (especially in young patients)

More expensive than using autograft

Dependence on tissue bank availability

Higher risk of infection or disease transmission because of allograft use

Slower biological incorporation of graft

Fast rehabilitation not advisable

ACL, anterior cruciate ligament; ALL, anterolateral ligament.