Surgical Technique for the Use of Allografts as Anterior Cruciate Ligament, Posterior Cruciate Ligament, Medial Collateral Ligament, and Lateral Collateral Ligament Substitutes

Abstract

The use of allograft tissue represents a compelling way to address ligamentous laxity of the knee. We describe our surgical techniques for their use as anterior cruciate, posterior cruciate, lateral collateral and medial collateral ligament substitutes. Arthroscopically assisted techniques are used in the allograft replacement of the anterior cruciate and posterior cruciate ligaments. Either achilles tendon or patellar tendon allografts are used. In each case, secure fixation is attained both proximally and distally so that early motion and rehabilitation is permitted. Lateral ligamentous reconstruction is performed using a “scissor-tail” achilles tendon allograft; an open approach is used. Bone block fixation is used on the lateral femoral condyle while the graft tails are brought individually through the tibia and fibula and appropriately tensioned. so that they act as separate ligamentous restraints on the lateral and posterolateral aspects of the knee. Medial collateral ligament reconstruction also uses an achilles tendon allograft. An open approach is used in which the remaining autogenous tissue is utilized as the deep portion of the ligament. The allograft is then placed into the appropriate anatomic (isometric) position and secured proximally and distally with posterior oblique ligament reinforcement. In each case, attention to isometry and restoration of constraints of these ligaments is required to afford the patient the best chance to regain functional knee stability and motion.