Surgical technique: development of an anatomic medial knee reconstruction

Abstract

Background: The main static stabilizers of the medial knee are the superficial medial collateral and posterior oblique ligaments. A number of reconstructive techniques have been advocated including one we describe here. However, whether these reconstructions restore function and stability is unclear.

Description of technique: This anatomic reconstruction technique consisted of reconstruction of the proximal and distal divisions of the superficial medial collateral and the posterior oblique ligament using two separate grafts.

Patients and methods: We prospectively followed all 28 patients (19 male, nine females) who had this new reconstruction between 2007 and 2009. The average age was 32.4 years (range, 16-56 years). There were eight acute and 20 chronic injuries. All patients presented with side-to-side instability with activities of daily living and other higher level activities. Minimum followup was 6 months (average, 1.5 years; range, 0.5-3 years). No patients were lost to followup.

Results: Preoperative International Knee Documentation Committee subjective outcome scores averaged 43.5 (range, 14-66) and final postoperative values averaged 76.2 (range, 54-88). Preoperative valgus stress radiographs averaged 6.2 mm of medial compartment gapping compared with the contralateral normal knee, whereas postoperative stress radiographs averaged 1.3 mm.

Conclusions: Early observations suggest this anatomic reconstruction technique improves overall patient function and restores valgus instability.

Figures

Fig. 1

A diagram of a right knee illustrates the superficial medial collateral ligament (sMCL) and posterior oblique ligament (POL) reconstruction grafts. Reprinted with permission of SAGE Publications, Inc, from Coobs BR, Wijdicks CA, Armitage BM, Spiridonov SI, Westerhaus BD, Johansen S, Engebretsen L, LaPrade RF. An in vitro analysis of an anatomic medial knee reconstruction. Am J Sports Med. 2010;38:339–347. Copyright © 2009, American Orthopaedic Society for Sports Medicine.

Fig. 2

A photograph of a left knee demonstrates the course of the superficial medial collateral ligament (arrows).

Fig. 3

A photograph of a right knee demonstrates the relationships between the femoral attachments of the superficial medial collateral ligament (scissors deep to superficial medial collateral ligament), the posterior oblique ligament, and the adductor magnus tendon (in forceps). SM = semimembranosus; MGT = medial gastrocnemius tendon.

Fig. 4

A photograph of a left knee demonstrates the posterior oblique ligament (POL) and superficial medial collateral ligament (sMCL) grafts passed into their femoral tunnels.

Fig. 5A–B

(A) Preoperative and (B) 2-year postoperative valgus stress radiographs of a left knee after an anatomic medial knee reconstruction are shown.

Fig. 6

An intraoperative photograph demonstrates the 6-cm distance between the medial joint line and the distal superficial medial collateral ligament attachment (left knee).

Fig. 7

A photograph of a left knee demonstrates the meniscofemoral and meniscotibial divisions of the deep medial collateral ligament. Superficial medial collateral ligament and posterior oblique were removed. MM = medial meniscus.