**5.3 Arthroscopic-assisted anatomic PLT reconstruction-surgical technique**

The patient is positioned supine with a thigh tourniquet applied on operated leg, which is placed in a leg holder. The procedure is performed using standard anterolateral (AL) and anteromedial (AM) portals. When the diagnosis of PLC injury is confirmed, semitendinosus tendon (ST-T) is harvested, prepared as a graft and double folded on the suspensory fixation device. Then, additional arthroscopic portals are created: mid-lateral, which was described in the section about PLT tenodesis, and high mid-lateral portal, which is situated at the level of PLT femoral attachment. A retraction suture may be placed on PLT to facilitate maneuvering. With the knee in full extension tibial popliteus aiming guide (K.H prototype) or an ACL tibial aiming guide is used to create tibial tunnel for PLT reconstruction. Senior author prototype allows to drill the tunnel from posterolateral to anteromedial direction without the risk of uncontrolled common peroneal nerve injury, whereas an ACL aiming guide enforces the surgeon to drill in anteromedial-posterolateral direction. The tibial tunnel should be positioned as it was previously described for PLT tenodesis. The drill matched to the size of the graft is used to create the tunnel. Then the knee is flexed to 90°. An eyelet pin introduced through high mid-lateral portal is placed in the PLT femoral attachment and used as an aiming guide to direct the femoral tunnel to the point just above the medial femoral epicondyle. Then the drill matched to the size of the ST-T graft is used to create the tunnel. A passing suture is passed through the eye in the eyelet pin and the pin is pushed medially to introduce the passing suture into the femoral tunnel. The second passing suture is grasped with an arthroscopic grasper inserted through tibial tunnel and pulled out through tibial tunnel outside the joint. It is important to have both passing sutures in mid-lateral portal without tissue bridges between them. At first, the ST-T graft is passed with passing suture through tibial tunnel, then passed below the skin and introduced with the second

passing suture to femoral tunnel. The graft is fixed on medial femoral cortex with suspensory cortical device and on the anteromedial tibial cortex with cortical button (**Figure 10**). In this way an anatomic PLT reconstruction was performed.
