Anterior Cruciate Ligament (ACL) Tears: Anterolateral Ligament (ALL) Reconstruction

Anterior Cruciate Ligament (ACL) Tears: Anterolateral Ligament (ALL) Reconstruction

This surgical video demonstrates an anterolateral ligament reconstruction. The anterolateral ligament, or ALL, is a small ligament located at the outer side of the knee. It helps the anterior cruciate ligament, or ACL, support the stability of the knee, and it is often also injured with ACL injuries. This procedure is completed in addition to an ACL reconstruction to reinforce the stability of the knee joint following surgery.

Here we see a right knee with the outer side of the knee facing the screen. The surgeon has already used a skin marker to mark out where the incisions will be made. Starting at the bottom of the thigh bone, or femur, the surgeon cuts through the skin and underlying soft tissue, including the IT band. The surgeon uses a bone punch and a guide to create a hole in the thigh bone. Then, a soft body anchor is placed into the guide and malleted into the bone. This anchor is already threaded with sutures with loops in place.

The surgeon transitions to the shinbone, or tibia. The surgeon cuts through the skin and underlying soft tissue. A drill and drill guide are used to create a hole in the shinbone. Then, another soft body anchor is placed into the guide and malleted into the bone. This anchor is also threaded with sutures, but it only has one loop.

A tendon graft has already been prepared. The surgeon places the graft into the 2 loops of the anchor in the thigh bone. The suture ends are pulled slowly to bring the graft tight to the bone. The ends of the graft are stitched together with sutures.

Using a shuttling suture, the graft is passed under the skin and IT band and out of the incision on the shinbone. Then, the surgeon passes the graft through the loop of the anchor in the shinbone and pulls the free suture end to tighten the graft to the bone. The end of the looped suture is cut, the excess graft is cut, and knots are tied to secure the graft in place.

The skin incisions will be closed with sutures, and the procedure is complete.