Abstract
Objectives:
Present a combined ACL and anterolateral ligament (ALL) reconstruction technique using a rectus femoris tendon graft harvested in a minimally invasive approach without specialized instruments.
Methods:
The graft is harvested from the lateral portion of the rectus femoris tendon. The distal end is detached from the patella, and dissection is extended proximally by 8 cm, ensuring preservation of the intermediate and deep layers of the quadriceps tendon (QT). A closed tendon stripper is carefully pushed with the knee at 20 degrees of flexion. The graft is folded asymmetrically, with the distal portion forming a double or triple graft for the ACL, and the proximal portion remaining unfolded for the ALL. The femoral tunnel is made using an outside-in technique, replicating both the ACL and ALL footprints.
Results:
The graft length typically ranges from 28 to 35 cm, and the ACL portion diameter ranges from 8 to 10 mm. The technique showed a low rate of complications and provided adequate control of pivot shift. Advantages include predictable graft diameter, use of standard instruments, and preservation of hamstring strength. Disadvantages include potential quadriceps strength reduction, risk of hematoma, an additional incision, and the need for an extra screw for ligament fixation.
Conclusion:
To our knowledge, this is the first report of a combined ACL and ALL reconstruction technique using a QT graft. The minimally invasive rectus femoris graft approach offers a viable alternative for combined ACL and ALL reconstruction in both primary and revision surgeries.