New autografts in PLC lesions Oliveira MG et al. three weeks before hospital admission (6). Patients were excluded if they had neurological or vascular lesions or fractures around the knee, or if they had compromised integrity of the fascia lata or the biceps femoris tendon. All patients were evaluated and operated on by the same team using the techniques described below. The study was approved by the Ethics Committee of the Faculdade de Cieˆncias Me´dicas da Santa Casa de Miserico´ rdia de Sa˜o Paulo, and the patients gave written informed consent for surgical procedures in the hospital in which they were operated. A clinical evaluation was performed with objective and subjective parameters. We used item 4 of the International Knee Documentation Committee (IKDC) as an objective parameter with which to assess ligament laxity, which was classified into four grades: normal (1 to 2 mm), close to normal (3 to 5 mm), abnormal (60 to 10 mm) and very abnormal (greater than 10 mm). Although all patients underwent Lachman, anterior and posterior drawer, varus stress and posterolateral drawer tests, the results of these tests are only demonstrated in this study in relation to the varus stress and posterolateral drawer results. For the subjective evaluation, we used the Lysholm scale, which ranged from 0 to 100 points and ranks the results as excellent (95 to 100), good (84 to 94), regular (65 to 93) and poor (less than 64). In the medical records, the Lysholm evaluation results were only available for 114 patients. The patients were evaluated before the surgery and again at 12 months postoperatively. After a year of postoperative follow-up, the patients were questioned with regard to their personal satisfaction in performing the activities of daily living, answering either yes or no. Surgical technique Under spinal anesthesia, each patient was subjected to a clinical evaluation to identify all of the injuries to the posterolateral corner of the knee, which were operated on by the same route. The associated lesions (or those of the anterior cruciate ligament [ACL] or posterior cruciate ligament [PCL]) were treated by arthroscopy during the same surgery. Access An incision approximately 12 cm long was made on the side of the thigh, in the lower limit of the iliotibial tract projection, from the middle third of the distal femur. This incision was made with the knee flexed at 30 degrees, extending to the region between the fibular head and Gerdy’s tubercle (Figure 1). The skin and subcutaneous tissue were opened, and we initially attempted to identify and isolate the peroneal nerve (the common fibular nerve) in the path that is superior and posterior to the fibular neck. Next, we identified the iliotibial tract and biceps femoris tendon, and prepared the grafts as described below. A section of the biceps femoris tendon was removed (7-cm long and with two- thirds of its original width) while maintaining its distal insertion on the fibular head. On its free end, a 2.0-cm-long suture was made (Figure 2). The iliotibial tract graft was removed (14 cm long and 3.0 cm wide), and its insertion into the tubercle of Gerdy was preserved. A 2.0-cm-long suture was made in its free end, and the iliotibial tract was then divided into two bands of 1.5 cm each. One of the bands remained in Gerdy’s CLINICS 2012;67(6):597-602 Figure 1 - Surgical access. tubercle, and a 2.0-cm-long suture was made in the other using the Kawano et al. technique (16). The construction of tunnels for the grafts took into account the following points of isometry (Figure 3): N The fibular collateral ligament – the anterior region of the fibular head, with the posterior region of the lateral epicondyle of the femur; N The popliteofibular ligament – the posterior region of the fibular head with the anterior lateral femoral epicondyle; N The popliteus tendon – 1.5 cm below the intra-articular line, in the posterior cortex of the lateral tibial plateau, with the anterior region of the lateral femoral epicon- dyle. Preparation of tunnels The tunnels were constructed as follows (Figure 4): Fibular collateral ligament – the femoral insertion was made 5 mm posterior and proximal to the midpoint of the lateral femoral epicondyle with a drill 7 mm in diameter and 2.5 cm in depth; 598 Figure 2 - Preparation of the grafts.