This article introduces a novel, single-session surgical technique for patients with concurrent anterior cruciate ligament (ACL) and posterolateral corner (PLC) injuries. The procedure, which combines an all-inside ACL reconstruction with a minimally invasive PLC reconstruction, offers a comprehensive solution using autografts from the patient’s own hamstring tendons. This approach is designed to restore stability, minimise patient morbidity, and streamline the surgical process.
Addressing Complex Knee Instability
ACL injuries, particularly when combined with damage to the posterolateral corner, can lead to significant rotational instability in the knee. Without addressing both issues, the risk of graft failure and persistent instability after surgery remains high. Traditional methods for combined ligament reconstruction often involve multiple, larger incisions and extensive dissection. This new technique aims to overcome these challenges by using a single, minimally invasive approach.
The All-Inside Translateral Technique
The surgical method described in the article leverages an “all-inside” approach for the ACL reconstruction, which is a significant advancement in itself. This technique involves:
- Single Autograft Source: The procedure uses the patient’s own semitendinosus and gracilis tendons from the same leg, preserving bone and reducing the morbidity associated with graft harvesting.
- Anatomic Sockets: Rather than full tunnels, the all-inside method uses retrograde drilling to create small, blind-ended sockets for graft passage. This preserves more bone stock and allows for more precise, anatomical graft placement.
- Minimally Invasive PLC Reconstruction: For the PLC, the gracilis tendon is used to recreate the key ligaments of the posterolateral corner, restoring rotational stability without the need for extensive soft-tissue disruption. This is done through minimal incisions, further reducing trauma and aiding a quicker recovery.
By combining these innovative, minimally invasive steps, the technique offers a more efficient and less traumatic solution for complex knee injuries. The authors provide a detailed, step-by-step guide for other surgeons, highlighting how this combined procedure can be a highly effective method for restoring knee function.
This review highlights the evolution of the all-inside ACL reconstruction technique, pioneered by Professor Adrian Wilson. The concept of using a single hamstring (semitendinosus) for the primary ACL graft allowed for preservation of the gracilis tendon — previously harvested as part of the standard four-strand construct. Building on this innovation, Professor Wilson developed a novel, minimally invasive posterolateral corner (PLC) reconstruction using the preserved gracilis tendon reinforced with FiberTape® to create a composite graft. This technique employs a two-window approach: a small femoral incision for tunnel preparation and a second incision over the fibular head. The peroneal nerve is carefully dissected and protected, and the graft is passed through the fibular tunnel and femoral socket in the correct anatomical layer. The technique, described in detail in his original publication, has since gained widespread adoption globally, demonstrating the power of combining tissue preservation with modern reinforcement materials like the internal brace — an innovation he co-developed and patented with Arthrex.
The full research paper is available for an in-depth review of the complete findings, methodology, and analysis.
Sources used in report overview:
- https://pubmed.ncbi.nlm.nih.gov/28580250/
- https://pmc.ncbi.nlm.nih.gov/articles/PMC5442462/
- https://www.imrpress.com/journal/FBL/27/3/10.31083/j.fbl2703091/htm
