Lateral extra-articular augmentation of ACL reconstruction

Reconstruction of the anterior cruciate ligament (ACL) is a common orthopedic procedure. It has been suggested that a single-bundle reconstruction does not completely control tibial anterior translation and rotation in all cases. Several techniques have been described to improve stability, including double-bundle intra-articular reconstruction and lateral extra-articular augmentation. Extra-articular augmentation has been suggested in patients with significant anterolateral rotatory instability, cases of revision ACL reconstruction, and when one wishes to protect the ACL graft from excess force such as in collision athletes. It is contraindicated for patients with posterolateral corner injuries and for the skeletally immature patients. The procedure described in this report uses a patellar tendon autograft for the intra-articular portion and a gracilis autograft for the extra-articular augmentation. Fixation of the gracilis tendon is achieved by a press-fit technique on the femur and through a drill hole in Gerdy tubercle on the tibia. Reported outcomes are variable, but lateral augmentation has been shown in some series to control rotational instability more effectively than isolated single-bundle or double-bundle intra-articular reconstruction. More work is required to completely define the indications.