FIGURE 1:

The posterolateral reconstruction surgical technique mirrors that of the anterolateral reconstruction. The only significant difference is the location of the distal and proximal tunnels. To establish the proximal tunnel, a site just anterior to the lateral collateral ligament is identified (Fig 1). A guide wire is placed in this position. The foot is then internally rotated, thereby exposing the head of the fibula.

FIGURE 2:

To establish the distal tunnel, a guide wire is drilled obliquely through the head of the fibula, angling from posterior proximal to anterior distal, and then exiting through the skin anteriorly (Fig 2). Like the anterolateral reconstruction, isometry is evaluated using a suture.

FIGURE 3:

The final tunnels are drilled and with the knee in approximately 90 degrees of flexion the graft is placed (Fig 3). Direct tendon to bone fixation is accomplished using bioabsorbable interference screws. Under tension, the femoral insertion is fixed first, followed by the fibular insertion. Excessive external foot rotation, as demonstrated by the dial test, should be eliminated.