In this video, we'll be demonstrating repositioning of the lateral cruciate, which is useful in cases of vertical malposition. First, examining the axis of the lateral cruciate, it's directed toward the medial canthus. This is a vertically malpositioned lateral cruciate as normally the axis should be toward the lateral canthus. We'll undermine the mucosa from the undersurface of the lateral cruciate. This is done completely. We incise the scroll junction so as to completely allow us to continue the dissection out laterally. Carefully taking off the skin and soft tissues from the lateral cruciate all the way down to the piriform, including the accessory cartilages. Then, the mucosa is taken away from the undersurface of the lateral cruciate. So we've completely released and completely elevated the entire lateral cruciate from the piriform all the way up to the genu. Next, our cephalic trim will be done or other maneuvers, whatever is chosen in this case. We're going to be doing a cephalic trim for this particular demonstration. We're going to be leaving behind about 7 millimeters of width of the lateral cruciate. And then, using rib cartilage or septal cartilage will create a lateral crural strut. And we're going to support that with a 25-gauge needle as we place 5-0 PDS sutures using a tapered needle through the lateral cruciate where we have the lateral crural strut on the undersurface. We'll place a couple of these horizontal mattress sutures. And once they're tied, we're then going to be creating a pocket to reposition the lateral cruciate. An additional benefit of the lateral crural strut when supporting a malposition case is that you'll have a straightening effect of the lateral cruciate when you have cases of concavity or convexity. This will help that as well. Then, between the mucosa and the skin soft tissue of the ala, we're going to be creating a pocket. This will allow us to place the graft so that it will align a proper orientation angled upward toward the lateral canthus. We're going to be parachuting this graft in. So, in this instance, I'm using a 5-0 PDS. Once again, I'm securing it to the distal aspect of that lateral cruciate. And I'm going to be doing an external tie. There are other ways to do this, but it is important that this graft be secured on the lateral aspect of the piriform. You don't want it to be falling in within the piriform aperture. Otherwise, you might still have an external valve compromise. And we're going to tie the suture externally through that single stab. This will be removed at the time the patient comes to the first post-operative visit. And you see the result is a straighter and more secure, stable lateral cruciate with an orientation toward the lateral canthus.

surgical technique

lateral cruciate

lateral crural strut

5-0 PDS sutures

post-operative