A Simple and Atraumatic Loop-Passing Technique for Tibial Anterolateral Ligament Graft Passage in Sonnery-Cottet Anterior Cruciate Ligament + Anterolateral Ligament Reconstruction.

The purpose of this technical note is to describe a simple and atraumatic loop-passing technique that facilitates tibial anterolateral ligament (ALL) graft passage in Sonnery-Cottet combined anterior cruciate ligament and ALL reconstruction. In the Sonnery-Cottet technique, 2 converging tibial tunnels are created for the ALL, requiring a passing loop to shuttle the graft between tunnels. Conventionally, a needle-mounted braided suture is advanced blindly through subcutaneous tissue, which can be unreliable in patients with thick subcutaneous tissue and may increase the risk of cortical breach or extraosseous passage. We describe a knot-pusher-assisted loop-passing technique using a 0 silk suture. A knot pusher loaded with the silk suture is introduced through 1 tibial tunnel and positioned at the tunnel convergence zone. The silk loop is retrieved from the second tunnel using a probe, creating a continuous loop for graft passage. This technique provides a simple, reliable, and atraumatic method for tibial ALL graft passage in Sonnery-Cottet combined anterior cruciate ligament and ALL reconstruction.