Journal: Arthroscopy Techniques
Article Title: Anatomic Flat Double-Bundle Medial Collateral Ligament Reconstruction
doi: 10.1016/j.eats.2023.03.017
Figure Lengend Snippet: Anatomic technique for medial collateral ligament (MCL) reconstruction performed using flattened double-bundle allograft such as peroneus longus or semitendinosus graft. Intraoperative physical examination includes valgus stress testing at 0° and 20°. The surgical procedure begins with the patient positioned supine on the operating room table. A skin incision is made extending from the medial femoral condyle to the pes anserinus. The fascia overlying the pes anserinus is thereafter opened in such a manner that it can be closed afterward. The anterior and posterior borders of the distal MCL are visualized, and a K-wire is placed at the center of the distal tibial insertion of the superficial MCL (sMCL), approximately 6 cm below the joint line. The femoral MCL insertion is visualized and palpated, and a K-wire is placed in the anatomic center of the MCL origin. Graft isometry is checked throughout joint range of motion by wrapping a suture around both K-wires. The ends of the suture are then clamped at the proximal femoral K-wire. Suture displacement should not exceed 1 to 2 mm as the knee is ranged from flexion to extension, starting from 30°. Once graft isometry has been confirmed, one 5.5-mm Healix Advance PEEK anchor and one 5.5-mm Healix Advance BR anchor with 4 nonabsorbable sutures and needles are placed: one at the distal tibial insertion of the sMCL and the other about 10 mm below the joint line, central to the course of the native MCL, at the proximal insertion of the sMCL. The femoral guidewire is removed and changed to a Beath pin to pass the sutures. The looped MCL allograft is thereafter placed and tied firmly to the distal tibial sMCL suture anchor. Each graft arm is additionally tied to the proximal tibial suture anchor to provide a second tibial attachment closer to the joint line. Both proximal graft ends are now whipstitched together at a length of at least 25 mm using a No. 2 nonabsorbable suture. Any excess graft should be removed at this point. The femoral guidewire is then over-reamed using a drill based on the diameter of the whipstitched graft. The lead sutures are shuttled through the bone tunnel and lateral soft tissue using the Beath pin, allowing the insertion of the graft into the bone tunnel. With the knee in 30° of knee flexion and neutral rotation, a fully threaded cannulated Bioresorbable Matryx Interference Screw is inserted over a nitinol guidewire. The sutures of the proximal and distal tibial suture anchors are now used to tie the MCL graft with whipstitches to the native MCL, followed by cutting of the remaining sutures, to obtain the final flat double-bundle MCL reconstruction.
Article Snippet: With the knee in 30 degrees of knee flexion and neutral rotation a fully threaded cannulated Bioresorbable Matryx Interference Screw (ConMed) is inserted over a nitinol guidewire.
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