Independent Anatomic Double-Bundle Anterolateral Ligament Reconstruction Using a Pedicled Gracilis Graft During Anterior Cruciate Ligament Reconstruction.

Recent studies on the anatomy and biomechanics of the anterolateral ligament (ALL) have highlighted its fundamental role in rotational control of the knee. These findings have led to the integration of its reconstruction into anterior cruciate ligament (ACL) reconstruction strategies, in order to improve management of residual pivot shift and optimize knee stability. This article describes a minimally invasive technique for ALL reconstruction, independent of the ACL. The procedure is based on the use of a pedicled autograft of the gracilis tendon. The ALL reconstruction follows a pedicled approach, ensuring optimal anatomical and biomechanical restoration. The graft is first directed to the distal insertion of the native ALL on the tibia, equidistant between Gerdy's tubercle and the head of the fibula, then routed to its femoral insertion, passing deep under the iliotibial band, next back on itself before being redirected to its initial point of emergence in the tibial tunnel. After fixation at the femoral level, tibial anchoring is performed in full extension to optimize isometry.