On-lay Anatomical Reconstruction of the Superficial and Deep MCL and POL With Hamstrings Tendons Autograft
Silvia Cardarelli, Valerio Nasso, Alessandro Carrozzo, Veronica Giuliani, Edoardo MonacoBackground:
Injuries to the medial collateral ligament (MCL) and the posterior oblique ligament (POL), isolated or associated with cruciate ligament tear, are common in cases of knee sprains and often cause valgus instability. Although there are many surgical techniques for MCL reconstruction, not all are anatomical, and not all involve reconstruction of the deep and superficial bundles of the MCL and POL with an autologous autograft.
Indications:
We propose this technique in cases of chronic anterior cruciate ligament (ACL) tear associated with POL and MCL injury grade III according to the Hughston-Eilers classification.
Technique Description:
This technique involves an on-lay anatomical reconstruction of the superficial and deep bundles of the MCL and POL using hamstring tendons. The patient is in a supine position with the knee flexed at 90°. An incision is made in the medial compartment of the knee, at the level of the medial collateral ligament, after which the hamstring tendons are harvested with an open tendon stripper so that they can be left inserted at their tibial insertion. Three soft tissue self-punching anchors are positioned at the anatomical insertion of the MCL and POL bundles. Care must be taken not to involve the joint surface, which is easily visible through a needle. The tendons are secured using the previously positioned anchors to reconstruct the MCL and POL.
Results:
After 5 months, the patient returned to her daily activities, fully recovered knee range of motion, and achieved good recovery of muscle strength without discomfort or functional limitations.
Discussion/Conclusion:
This technique provides an anatomical reconstruction of the MCL and POL using on-lay all suture anchors for chronic lesions. Hastring autografts are used for MCL and POL reconstruction, leaving other autografts available for ACL reconstruction. There is no need for an additional tunnel for MCL and POL reconstruction, thus avoiding tunnel convergence in multiligament reconstructions.
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.