Chronic anteromedial rotatory instability of the knee: technique and results of a near-anatomical reconstruction

Abstract

Background Superficial and deep medial collateral ligament (MCL) together with the posterior oblique ligament (POL) works in harmony to control anteromedial rotatory instability (AMRI) throughout the knee range of motion (ROM). Associated anterior cruciate ligament (ACL) injury will accentuate the instability in all directions, adding more challenge to the management plan. This pattern of injury is a common type of combined ligamentous knee injury. Hypothesis Near-anatomical reconstruction of both ACL/MCL will restore knee AMRI to normal, with minimal ROM deficit. Patients and methods Twenty-five patients with chronic combined ACL and MCL injury (>3 months since injury) were included in this study. Anatomical ACL with percutaneous MCL–POL were performed and the patients were assessed at 2 years for knee stability, ROM, and complications. Results The mean subjective International Knee Documentation Committee scores for the patients were 43.32±7.58, range 28–60; at the end of follow-up, the mean was 94.76±3.7, range 89–100, P value less than 0.0001. The knee stability was restored to normal in 84% of patients and nearly normal in 16% of patients. Conclusion Anatomical ACL with percutaneous MCL–POL reconstruction yields very good results in cases of chronic AMRI. This technique is associated with little morbidity and can be done through minimally invasive incisions.