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The main goal in anterior cruciate ligament reconstruction (ACLR) should be to restore normal knee biomechanics so the chances of failure decrease. The persistence of knee instability after ACLR goes from 0.7% to 20%. Several factors have been identified and studied, but there are some selected cases in which it seems that without adding lateral extra-articular tenodesis (LET) it is not possible to control rotational instability. Data exist supporting that LET could reduce pivot shift (PS), without losing flexion/extension range of motion nor adding risk of osteoarthritis. Recently, LET has been used in addition to ACLR to add restriction to internal tibial rotation forces, and different authors have shown their techniques to achieve this task. Also, biomechanical studies have compared different techniques for LET procedures. This article aims to describe our technique performing a modified Macintosh LET as an addition to ACLR in selected patients who require extra internal tibial rotation control. This is a reproducible, easy to learn, and inexpensive procedure in terms that only a high resistance suture is needed and not any other implant, such as a stapler, anchors, or screws, reducing the risk of tunnel coalition.

Objective The aim of the present study is to assess the return to play among amateur soccer league players after anterior cruciate ligament (ACL) reconstruction. Materials and Method The surgical protocols of ACL reconstruction surgeries performed in a sports medicine clinic from July 1st, 2013, to June 30th, 2014, were included in the study. Only the charts of amateur soccer league players who played once or twice a week were selected. The follow-up time was calculated as the number of months between surgery and the telephone survey. At the follow-up, the current status of the soccer playing was recorded. Those patients who were no longer playing in a team were asked what kind of sport they were currently practicing, as well as the main reason for not returning to team playing. Results A total of 61 (25.6%) patients met the inclusion criteria. The mean follow-up time was of 22.4 ± 3.4 months. At the follow-up, 30 (49.1%) patients were playing in amateur soccer teams. Among the patients who were no longer playing in a team, 19 (61.2%) were playing soccer occasionally, 11 (35.4%) were practicing other sports, and 1 developed a sedentary life style. The reasons for not returning to team playing were: fear of reinjury in 26%; knee symptoms in 26%; lack of confidence in the knee in 23%, family or job commitments in 23%; and not being eligible to participate in competitive sports in 2%. Conclusion After an average of two years of ACL reconstruction, only half of the amateur soccer league players return to play.

Several factors associated with graft preparation for the surgery of the anterior cruciate ligament (ACL) like the wrong thawed, prophylaxis, bone cuts, excessive bone removal as well as positioning problems like a tunnels-graft mismatch, insufficient harvesting of the donor's tendon, size graft limitations (length and diameter), uncontrolled rotation of graft in their longitudinal axis, over or under tensioned graft, fixation mistakes, bone defects, secondary arthrofibrosis or morbidity of the donor site, and others factors importantly affect the outcomes of the ACL surgery. In this sense, the Achilles tendon Allograft is an advantageous technique where many of the previous limitation factors described can be controlled during an appropriate preparation. However, to obtain the maximum potentialities of the graft a detailed knowledge of the preparation is required. Hence, we aimed to describe how to prepare the Achilles tendon Allograft to control the graft's length and diameter, bone removal, and fixation requirements.

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