Outside-In Anterior Cruciate Ligament Revision With Lateral Tenodesis and High-Strength Suture Augmentation Is Easy to Perform With the Iliotibial Band

Abstract We describe a technique for revision anterior cruciate ligament (ACL) surgery using a 15-cm strip of the iliotibial band as a graft and the gracilis tendon if available. An internal brace is added to augment the graft. The graft is passed through the femur by drilling an outside-in tunnel from the isometric point F9 of Krackow toward the ACL’s footprint and is then double fixed at the tibia using an interference screw and a cortical button. This technique makes it possible to perform simultaneous ACL reconstruction and lateral tenodesis with a continuous, rigid, good-diameter graft that is pedicled to the Gerdy tubercle. Good rotational control is achieved, and all the factors that contribute to ligamentization are present.