It is widely acknowledged that anterior cruciate ligament (ACL) injury is the cause of anterolateral insta-bility, but in some cases not only the ACL ruptures, but also anterolateral structures (ALS), including the antero-lateral ligament. Their insufficiency may be the cause of residual instability after ACL reconstruction, which significantly increases the risk of graft rupture. In the past, anterolateral instability caused by ACL injury was treat-ed with extra-articular reconstructions, including lateral extra-articular tenodesis. Nowadays those techni-ques are used simultaneously in cases of complex anterolateral and rotational instability. This article briefly describes historical methods of lateral tenodesis and presents step-by-step two techniques used in our depart-ments involving two alternative graft femoral fixation methods.
Keywords: anterior cruciate ligament; anterior cruciate ligament reconstruction; anterolateral instability; anterolateral ligament; iliotibial band tenodesis.