Anatomic Posterolateral Corner Reconstruction of the Knee Using Single Semitendinosus Autograft: Technical Note for the Borderline-length Graft.

The original LaPrade technique for anatomic reconstruction of the posterolateral corner of the knee uses two separate allografts. More recently, a modification of this technique, using an adjustable-length suspension device with a cortical button for tibial fixation, allows anatomic reconstruction with a single semitendinosus autograft. This modification is of utmost relevance when sources of allograft are not available for multiligament knee reconstruction. In both techniques interference screws are used for femoral fixation of the fibular collateral ligament and popliteus tendon. The minimum length recommended for the anatomic reconstruction with single semitendinosus is 25 cm, but anatomic variations in the population exist, and a longer semitendinosus may be necessary. Indeed, some patients may only reach the necessary length considering the thinnest limb of the semitendinosus. In these patients, femoral fixation of the thinnest limb with a knotless suture anchor, as we describe, for the popliteus tendon limb, allows expansion of this technique to borderline semitendinosus autografts while reducing the risk of tunnel coalition. We also describe a different sequence of steps: fixation of the fibular collateral ligament in the femoral tunnel followed by its tensioning and fixation in the fibular head tunnel, fixation of the popliteus tendon in its femoral footprint with a knotless suture anchor and, finally, tensioning of the popliteofibular ligament and popliteus tendon. This different sequence also helps avoiding tendon waste, which may be left over, allowing more graft incorporation into the tibial tunnel.