The Multiple Ligament Injured Knee by Gregory C. Fanelli

Author:Gregory C. Fanelli
Language: eng
Format: epub
Publisher: Springer New York, New York, NY

The posterior medial capsule is reattached with suture anchors to the posteromedial femur and/or tibia depending on the location of the injury. The posterior oblique ligament (POL) is sutured to the posterior border of the MCL without imbrication with the knee positioned in full extension.

18.13 MCL Reconstruction

18.13.1 Chronic

In the chronic setting, we typically recommend an Achilles tendon allograft or semitendinosus autograft. For the Achilles allograft technique, a K-wire is inserted at the MCL femoral origin by visual and fluoroscopic guidance (4). The MCL tibial origin is identified by the remaining fibers beneath the semitendinosus and gracilis tendons. A looped suture or Mersilene tape is placed around the K-wires at the origin and insertion sites to check for isometry in flexion and extension. A femoral socket (9 mm diameter, 25 mm length) is drilled with a reamer. The bone block is inserted and secured with an 8  ×  25 mm metal interference screw. Two suture anchors are placed at the medial tibial plateau margin and the sutures are passed through the graft, but not tied. A nonabsorbable, locking whip stitch is placed in the tibial end of the graft. The knee is placed in 30° of flexion with a varus and slight external rotation stress. The graft is then tensioned and fixed to the tibia with a bicortical screw/ligament washer, and the sutures are tied around the screw. This construct spreads out the tibial attachment site and provides secure, double fixation. The deep MCL sutures (suture anchors at the tibial plateau margin) are tied with the knee in full extension. Figures 18.8 and 18.9 depict case examples of ACL/PCL/MCL reconstructions using Achilles allograft for the MCL reconstruction.

Fig. 18.8Clinical photo of an Achilles MCL reconstruction

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