Recent interest in the anterolateral complex and rotatory instability after anterior cruciate ligament (ACL) reconstruction has resulted in a renewed interest in various surgical techniques that augment or restore the anterolateral complex. This video discusses various surgical techniques to restore rotatory stability. These techniques include lateral tenodesis, combined intra-articular and extra-articular reconstruction, and anatomic anterolateral ligament (ALL) reconstruction.

Lateral tenodesis typically involves the use of iliotibial band strips. From a biomechanical point of view, some agreement exists that the iliotibial band strip should be passed deep to the lateral collateral ligament and fixed proximal and posterior to the lateral collateral ligament insertion. Many techniques have been described for lateral tenodesis. This video describes the modified Lemaire technique, the MacIntosh technique, the Coker-Arnold technique, the Ferretti technique, and the recently published monoloop technique.

Combined intra-articular and extra-articular procedures involve the use of hamstring, the iliotibial band, or allograft. ACL reconstruction can be performed anatomically or nonanatomically, such as in the Marcacci technique. Typically, an extra-articular procedure involves nonanatomic reconstruction of the anterolateral complex. This video describes the Saragaglia technique (hamstring graft), the Marcacci technique (hamstring graft), and the Yamaguchi technique (iliotibial band graft).

Anatomic ALL reconstruction recently has been proposed. Techniques for anatomic ALL reconstruction include isolated ALL reconstruction or combined anatomic ACL-ALL reconstruction; however, ALL reconstruction always is performed anatomically. Various surgical techniques for anatomic ALL reconstruction have been described in the literature. This video describes the Sonnery-Cottet technique (combined ACL-ALL anatomic reconstruction), the LaPrade technique (anatomic ALL reconstruction with allograft), and the Helito technique (combined ACL-ALL anatomic reconstruction).