Vol.:(0123456789) 1 3 Knee Surgery, Sports Traumatology, Arthroscopy https://doi.org/10.1007/s00167-020-05885-x KNEE Plantaris tendon: a novel graft for anterolateral ligament reconstruction and additional reinforcement for anterior cruciate ligament autografts in combined reconstructive procedures Mario Josipović 1  · Josip Vlaić 2  · Jure Serdar 1  · Marko Šimunović 3  · Dinko Nizić 4  · Zdravko Schauperl 5  · Ivan Bojanić 1  · Mislav Jelić 1 Received: 13 September 2019 / Accepted: 23 January 2020 © European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2020 Abstract The anterolateral ligament is recently recognized as an important structure in restoring rotational stability of the anterior cruciate ligament-defcient knee. Biomechanical and clinical studies confrmed the benefts of concurrent anterior cruciate ligament and anterolateral ligament reconstruction. However, present techniques mostly use hamstring tendons autografts and therefore additionally disrupt the knee biomechanics. The plantaris tendon is a well known and accessible graft and has excellent biomechanical properties for anterolateral ligament reconstruction. The present paper describes a new combined anterior cruciate ligament and anterolateral ligament reconstruction technique using plantaris tendon and semitendinosus tendon. Level of evidence V (Case report). Keywords Anterolateral ligament · Plantaris tendon · Anterior cruciate ligament · Arthroscopy · Hamstring sparing Abbreviations 2PL Double plantaris tendon 3STT Triple semitendinosus tendon ACL Anterior cruciate ligament ALL Anterolateral ligament FH Fibular head GT Gracilis tendon GTB Gerdy’s tubercle LE Lateral epicondyle PL Plantaris tendon STT Semitendinosus tendon Introduction Biomechanical studies showed that kinematics of ACL recon- structed knee, regarding rotational stability, is closer to kin- ematics of ACL-defcient knee than that of ACL-intact knee [1, 9, 11, 19]. Therefore, the importance of anterolateral knee structures, namely anterolateral ligament (ALL), in providing rotational stability is recently recognized [1, 6, 8, 18, 25]. Several surgical techniques have been proposed for com- bined ACL and ALL reconstruction, most of which utilize autologous two hamstrings tendons, semitendinosus (STT) and gracilis (GT) [7]. Since hamstrings are ACL agonists their harvesting increases the risk of ACL graft rupture [5, 14, 28]. Therefore, the use of single instead of two hamstring tendons for ACL reconstruction is suggested [13, 15, 16, 26]. To avoid detrimental efects of harvesting two hamstring tendons in combined ACL and ALL reconstruction, the surgical technique was developed using STT and plantaris tendon (PL) autografts. Plantaris muscle is a small muscle * Mislav Jelić mislavorto@gmail.com 1 Department of Orthopaedic Surgery, University Hospital Centre Zagreb, School of Medicine, University of Zagreb, Salata 6-7, 10000 Zagreb, Croatia 2 Division of Paediatric Orthopaedic Surgery, Children’s Hospital Zagreb, Ulica Vjekoslava Klaica 16, 10000 Zagreb, Croatia 3 Department of Radiology, University Hospital Centre Zagreb, University of Zagreb School of Medicine, Kispaticeva ulica 12, 10000 Zagreb, Croatia 4 Department of Radiology and Ultrasound Diagnostics, Special Hospital for Pulmonary Diseases, Rockefellerova 3, 10000 Zagreb, Croatia 5 Department of Materials, Faculty of Mechanical Engineering and Naval Architecture, University of Zagreb, Ulica Ivana Lucica 5, 10000 Zagreb, Croatia