Extra-articular lateral reconstruction technique

This article describes an anterolateral reconstruction procedure that, when used in combination with an intra-articular anterior cruciate ligament (AC L) reconstruction, restores rotary and anterior knee stability. We believe that failing to recognize lateral instabilities and to perform an extra-art icular reconstruction is an under-recognized cause of failure of ACL recons truction. We also describe the indications, medical histories, and physical examination tests used to determine when an anterolateral reconstruction i s needed. One should suspect a compromise of the lateral structures when pr esented with a failed ACL reconstruction in which the tunnels, the graft, a nd the rehabilitation all seem to have been done properly, or when a prior lateral procedure has been attempted and failed. In our experience, if a se cond ACL reconstruction is undertaken without the benefit of a lateral reco nstruction, it may fail as well.