Combined, Pedicled Anterior Cruciate Ligament and Anterolateral Ligament Reconstruction - “PAAR” Technique

Despite constant development of surgical implants, instruments, and rehabilitation protocols, the outcomes of anterior cruciate ligament reconstruction remain unpredictable, and the failure rate of isolated procedures remains unacceptably high. Several factors possibly concerning suboptimal outcomes and risk of graft rerupture have been highlighted, among which are graft healing, tunnel position, and residual rotational instability. Recent studies have suggested that addressing anterolateral complex injury and enhancing graft healing properties might improve the outcomes of surgery. We propose a simple technique of combined anterior cruciate ligament and anterolateral ligament reconstruction using pedicled semitendinosus and gracilis tendons with a single femoral tunnel and no additional tibial tunnels.