MCL Reconstruction Using a Flat Tendon Graft for Anteromedial and Posteromedial Instability

Elisabeth Abermann,Guido Wierer,Mirco Herbort,Robert Smigielski,Christian Fink

doi:10.1016/j.eats.2021.10.019

Abstract

The main principles of the present medial collateral ligament (MCL) reconstruction techniques are (1) to approximate the natural anatomy and (2) to restore the main passive restraining structures in anteromedial and posteromedial knee instability. Therefore, we describe a technique using a flat tendon graft instead of tubular grafts with point-to-point bone fixation. Moreover, we address the deep MCL, a relevant restraint to anteromedial instability.

Highlights

The medial collateral ligament (MCL) is the prime static stabilizer of the medial side of the knee joint
Biomechanical studies found that the superficial MCL is the major restraint to valgus rotation and external tibial rotation, especially in knee flexion
We describe a versatile reconstruction technique for the medial side of the knee in either type of instability pattern using a flat “ribbon-like” graft to be closer to native MCL anatomy compared with commonly used techniques with tubular graft types

Summary

Introduction

The medial collateral ligament (MCL) is the prime static stabilizer of the medial side of the knee joint It is important for providing support against valgus stress, rotational forces, and anterior translational forces on the tibia. A thigh tourniquet is applied, and knee motion between 0 and 100 flexion should be possible In this case, we prefer not to use a leg holder. Depending on the desired reconstruction (AML/sMCL or sMCL/POL), the anterior and posterior arm are folded either 1/3 to 2/3 or 2/3 to 1/3 of the graft length (Fig 3B, Video 1). In case of a confusing anatomical situation after chronic injury to the medial structures, a lateral view picture with fluoroscopy can help to find the correct femoral insertion, according to Harthorn et al.[25] (Fig 5). The guidewire is over-reamed with a 4.5-mm drill bit through the lateral cortex (Fig 6B)

Key Maneuver

Discussion