Weave Technique for Reconstruction of Medial Collateral Ligament and Posterior Oblique Ligament: An Anatomic Approach Using Semitendinosus Tendon

Abstract

Medial collateral ligament (MCL) is the most commonly injured ligament in knee. The majority of MCL tears can be managed conservatively, and reconstruction or augmentation is required in few selected cases. Anatomic MCL and posterior oblique ligament reconstruction have good functional outcome, but it requires 2 tunnels each in the tibia and femur, which may be a limitation in cases in which multiligament reconstruction is required. Several studies report the use of semitendinosus tendon with intact tibial attachment for MCL reconstruction. Since the attachment of semitendinosus is anterior to MCL footprint, it is non-anatomic and anisometric, which may lead to increased laxity of the reconstructed ligament in due course of time. To prevent the laxity in long term, the reconstruction has to be isometric and anatomic. We, hereby, are reporting our unique technique of MCL and posterior oblique ligament reconstruction using intact semitendinosus at tibial attachment and re-routing to the MCL which makes the reconstruction anatomic and isometric. A supplemental video demonstration of the technique is attached with this article.

Patterns of presentation and early treatment outcomes of anterior cruciate ligament injury at the National Orthopaedic Hospital, Lagos, Nigeria: a retrospective cross-sectional study

“…However, our value for non-contact injuries is lower than that observed in previous studies [ 15 , 21 ]. This may be related to the smaller sample size of our study.…”

Single-Row Repair in Chronic Medial Collateral Ligament Insufficiency

“…Joshi et al 15 modified the Kim et al technique 14 by rerouting and weaving the semitendinosus to tibial remnant of sMCL and reproducing a near-anatomical MCL and POL reconstruction, in contrast to LaPrade and Wijdicks, 13 but with only two tunnels and two implants. It was more anatomical and isometric than Kim et al's technique.…”

“…12 In chronic MCL insufficiency, the majority of consensus is toward operative management with MCL reconstruction using autograft or allograft. Popular techniques for MCL reconstruction like LaPrade and Wijdicks, 13 Kim et al, 14 and Joshi et al 15 are technically demanding procedures that require use of multiple grafts, multiple tunnel placement, and multiple fixation devices. These procedures and devices, therefore, make the procedure costly and challenging, especially in cases of multiligament reconstruction procedures.…”

Early medial reconstruction combined with severely injured medial collateral ligaments can decrease residual medial laxity in anterior cruciate ligament reconstruction

“…Our MCL reconstruction technique was similar to the technique described by Lind et al [24] and has several technical advantages. (1) The use of free hamstring grafts of quadrupled semitendinosus and the gracilis tendons with their distal attachments in place can prevent graft failure by repetitive friction of the ligament with acute bending around the tibial tunnel aperture [19]. (2) This technique also allows the reconstruction of the POL.…”