Fibular Collateral Ligament Reconstruction With Biceps Femoris Tendon Repair and Lateral Meniscal Radial Tear Repair With Combined Transtibial Tunnel Fixation and Inside-Out Hashtag Technique
Nicholas K. Retzer, Benjiman J. Wilebski, Ethan R. Sawyer, Taylor J Freetly, Luke V. Tollefson, Robert F. LaPradeBackground:
The fibular collateral ligament (FCL) is the primary restraint to varus stress at the knee. Concomitant injuries are common, including disruption of the menisci and the biceps femoris tendon. Radial tears of the lateral meniscus may occur with FCL injuries, and preservation through repair helps maintain the meniscal function.
Indications:
When an FCL injury is inadequately treated, patients may experience persistent instability, premature osteoarthritis, and an increased risk of graft failure in the setting of concurrent cruciate ligament injury. Anatomic FCL reconstruction (FCLR) has been shown to be preferable over repair. It is important to address all concomitant pathology associated with an FCL tear, given the known risk of progression to osteoarthritis. A widely separated radial tear may be addressed with a combined approach that includes a transtibial tunnel and an inside-out hashtag suture technique to achieve optimal reduction and fixation.
Technique Description:
The technique described was for an FCLR with a semitendinosus autograft, with concomitant repair of a lateral meniscus radial tear using a transtibial tunnel and inside-out hashtag technique. The femoral and tibial tunnels for the FCL were created first. A semitendinosus autograft was then harvested and prepared for an anatomic FCLR. Arthroscopy demonstrated a completely separated radial tear of the lateral meniscus, which was reduced through a transtibial tunnel. Inside-out vertical and horizontal mattress sutures were then placed to complete a hashtag repair. The FCL graft was fixed, and the torn biceps femoris tendon was repaired to the fibular head with a suture anchor.
Results:
Recent literature demonstrates favorable clinical outcome scores and patient satisfaction with anatomic FCLR. Another study reports an 80% clinical success rate for radial meniscal repair, with the lack of a transtibial tunnel being a potential risk factor for failure in patients with widely separated tears, supporting this comprehensive surgical strategy.
Discussion/Conclusion:
Combined lateral knee injuries require careful evaluation, and it is important to address all associated pathology. For widely separated radial meniscal tears, combining a transtibial tunnel approach with a hashtag inside-out suture configuration can create a stable construct that reapproximates the tear and facilitates healing.
Patient Consent Disclosure Statement:
The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.