Editorial Commentary: What to Reinforce When You Have a Small Anterior Cruciate Ligament Graft? Focus on the Anterolateral Side!

Many surgeons performing anterior cruciate ligament (ACL) reconstruction have encountered the problem of harvesting small hamstring grafts. For this situation, several options are available such as harvesting contralateral hamstring tendons, reinforce the ACL graft with allografts, take a bone-patellar tendon-bone or quadriceps graft or add an anterolateral ligament reconstruction or lateral extra-articular tenodesis. Recent studies have shown that the presence of a lateral extra-articular procedure might be more important than the thickness of an isolated ACL graft, which is reassuring news. Current evidence suggests that both anterolateral ligament reconstruction and modified Lemaire tenodesis are similar biomechanically and clinically and could solve the problem of small-diameter hamstring ACL autografts.