What can you tell me about an operation called a femoral-fibular posterolateral reconstruction for the knee? I’ve been told not to worry and that this is a common procedure used to restore stability to the knee. But I’d still like to know a little more before deciding if I want it or not.

Femoral-fibular posterolateral reconstruction is the most commonly used surgical technique to stabilize a knee with multiple ligaments that are damaged. Without this important soft tissue support, posterolateral (back and side) instability of the knee joint occurs.

To be more precise, the soft tissues being replaced are the fibular collateral ligament, the popliteus muscle tendon-ligament (PMTL), the popliteofibular ligament, and the posterolateral (joint) capsule.

When these structures are torn or damaged, the knee slides around and can partially dislocate (called subluxation) or fully dislocate. That’s what is meant by knee instability. Together, these soft tissues work to keep the knee joint from hyperextending (extending beyond a neutral position), externally rotating too far, or opening (gapping) too much along the side.

And that’s why it’s important to do more than just repair damage to this area. In this procedure, a piece of the Achilles tendon from the back of the heel is used to replace torn ligaments along the back (posterior) and side (lateral) aspect of the knee. The surgeon actually has to rebuild (reconstruct) this group of four ligaments and capsule that make up the back/side corner of the knee joint.

Basically, tunnels were drilled into the femur (thigh bone just above the knee) and into the fibula (small bone along the outside of the lower leg bone and located just below the knee joint). The Achilles tendon graft (taken from a tissue bank, not from the patient) is threaded through the tunnels with just the right amount of tension to mimic the natural ligamentous function.

The femoral-fibular reconstruction is a fairly simple procedure. The way the graft is put in and looped around actually makes a double graft. The extra strength of this configuration tied into the fibular collateral ligament (FCL) works well. The placement of the femoral-fibular graft forms a solid foundation for the complete reconstructive procedure.

This technique does restore joint stability. It allows lateral joint gapping needed for normal movement. But it prevents abnormal lateral joint opening when stress is applied to that side of the joint.

As a result, all three posterolateral structures are restored allowing for normal (or near normal) motion, function, and stability. This reconstructive procedure mimics the natural knee and that’s important for both daily activities and recreational sports.