Late Medial Collateral Ligament Reconstruction

Surgical Technique: Medial Collateral Ligament Reconstruction Using Achilles Allograft for Combined Knee Ligament Injury

“…This shows the new technique is unlikely to cause motion loss, probably as a result of the fact it is extra-articular, yet in one case of MCL with concomitant revision ACL reconstruction and in a case that involved ACL/PCL/LCL/PLC knee reconstruction, 15°flexion loss was observed. This observation supports the use of the technique described viewing that motion loss is expected after complex knee reconstructions that include MCL reconstruction and at least another cruciate reconstruction [8,17,20]. We found two studies reporting ROM and function in patients who had MCL reconstruction with one similar graft tissue in all patients and a similar specifically described a reconstruction technique for the MCL in a combined MCL and another cruciate reconstruction [17,20] (Table 3).…”

“…PCL laxity was assessed with the posterior drawer test at 908 knee flexion (graded as 0 for 0-2 mm side-toside difference, 1+ for 3-5 mm difference and with anterior medial tibial plateau located anterior to the medial femoral condyle, 2+ for 6-10 mm difference and with anterior medial tibial plateau located flush with the medial femoral condyle, 3+ for more than 10 mm difference and with anterior medial tibial plateau located posterior to the medial femoral condyle) [29]. MCL laxity was assessed with valgus stress test at 0°and at 30°knee flexion (graded as 0 for 0-2 mm side-to-side difference, 1+ for 3-5 mm difference, 2+ for 6-10 mm difference, 3+ for more than 10 mm difference) [8,14,30] in addition to the anteromedial rotatory instability test [13]. LCL/PCL laxity was assessed with a varus stress test at 0°and at 30°knee flexion (graded as 0 for 0-2 mm side-to-side difference, 1+ for 3-5 mm difference, 2+ for 6-10 mm difference, 3+ for more than 10 mm difference), external rotation with a posterior drawer test at 90°knee flexion (graded as 0, 1+ , 2+ , 3+), and a dial test at 30°knee flexion (considered positive with side-to-side difference greater than 15°) [7,29].…”

“…The indications for this procedure were (1) a subjective sense of instability; (2) increased valgus laxity after 10 weeks of nonoperative treatment with a brace, graded as between 2+ and 3+ or above in the injured knee compared with the uninjured knee (ie, a difference of between 6 and 10 mm for Grade 2+ and above 10 mm for Grade 3+) [8,14,30]; (3) concomitant ACL instability (ie, Lachman Grade 2B or above and a Grade 2+ pivot shift test) or posterior cruciate ligament (PCL) instability (ie, posterior drawer test Grade 2B or above at 908 flexion); and (4) arthroscopic finding confirming under valgus stress a medial compartment opening of more than 10 mm in the injured knee (this is measured with the tip of the arthroscopic probe used as a scale after its length is confirmed outside the knee). Open physis of the distal femur is an absolute contraindication for this surgery.…”

“…Nevertheless, because all operations were performed by a single surgeon, low technical variability of the MCL reconstruction is expected in our series, and this may be of particular importance when evaluating stability and function after the operation in such small numbers. Second, our outcome evaluation in terms of knee stability relied on physical examination according to an accepted grading system [8,14,30], but we did not use objective measures such as KT-1000 or stress radiographs. Third, because functional scores (ie, IKDC-subjective and Lysholm) were collected systematically only postoperatively but not preoperatively, postoperative improvement in function could not be quantified.…”

Medial Collateral Ligament Laxity in Revision ACL Reconstruction

“…19.9 ); (4) the skin is undermined from the femoral guide pin to the anatomic MCL insertion on the tibia, creating a tunnel for the graft under the subcutaneous fat (Fig. 19.10 ); (5) a nonabsorbable suture loop is placed around the guide pin and brought distally under the skin through the tunnel just created; (6) the distal suture is held against the tibia at the estimated anatomic insertion, just posterior to the pes anserinus insertion. Isometricity is tested through knee motion from 0 to 90°.…”