Posterolateral Corner Reconstruction of the Knee: Surgical Technique Utilizing a Bifid Achilles Tendon Allograft and a Double Femoral Tunnel

Reconstruction of the posterolateral corner of the knee has received increased attention in the recent literature. Basic science studies have helped us determine the 3 critical structures of the posterolateral corner: the lateral collateral ligament (LCL), the popliteus tendon, and the popliteofibular ligament. We have developed an anatomic posterolateral corner reconstruction that most closely resembles these 3 key structures and is based on the work of previous authors. Our technique is performed using a single Achilles allograft. The bone plug is secured in a femoral tunnel at the anatomic attachment of the popliteus tendon with an interference screw. The Achilles tendon is then split approximately 1 to 2 cm distal to the bone plug into 2 segments: (1) the popliteofibular ligament portion that is passed through a fibular tunnel starting at the anatomic attachment of popliteofibular ligament and fixed with a biointerference screw and (2) the static portion of the popliteus tendon securing this through a tibial tunnel passed from posterior to anterior right at the musculotendinous junction of the popliteus. The anterior limb of the Achilles tendon exiting the fibula is then brought back around, secured to the fibular attachment of the LCL with a suture anchor, and is then passed through a separate femoral tunnel placed at the anatomic attachment of the LCL.