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Tibial inlay reconstruction of the medial collateral ligament using Achilles tendon allograft for the treatment of medial instability of the knee

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Although various surgical procedures have been described for the medical collateral ligament (MCL) reconstruction, none can accurately reestablish its original anatomy and orientation. The purpose of this study was to present a technique restoring the anatomy and stability of the medial knee with an Achilles tendon allograft using a tibial inlay technique. The bone block was fixed into a cancellous trough created on the medial surface of the tibia with a cancellous screw and washer, while the tendinous portion was fixed into the femoral insertion site of the superficial MCL with a bioabsorbable interference screw. This technique can successfully reproduce the native anatomy and orientation of the MCL.

Level of evidence IV.

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References

  1. Berg EE (1995) Posterior cruciate ligament tibial inlay reconstruction. Arthroscopy 11:69–76

    Article  CAS  PubMed  Google Scholar 

  2. Brand JC Jr, Pienkowski D, Steelage E et al (2000) Interference screw fixation strength of a quadrupled hamstring tendon graft is directly related to bone mineral density and insertion torque. Am J Sports Med 28:705–710

    PubMed  Google Scholar 

  3. Feeley BT, Muller MS, Allen AA et al (2009) Biomechanical comparison of medial collateral ligament reconstructions using computer-assisted navigation. Am J Sports Med 37:1123–1130

    Article  PubMed  Google Scholar 

  4. Feeley BT, Muller MS, Allen AA et al (2009) Isometry of medial collateral ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 17:1078–1082

    Article  PubMed Central  PubMed  Google Scholar 

  5. Griffith CJ, Laprade RF, Johansen S et al (2009) Medial knee injury: Part 1, static function of the individual components of the main medial knee structures. Am J Sports Med 37:1762–1770

    Article  PubMed  Google Scholar 

  6. Griffith CJ, Wijdicks CA, Laprade RF et al (2009) Force measurements on the posterior oblique ligament and superficial medial collateral ligament proximal and distal divisions to applied loads. Am J Sports Med 37:140–148

    Article  PubMed  Google Scholar 

  7. Grood ES, Noyes FR, Butler DL, Suntay WJ (1981) Ligamentous and capsular restraints preventing straight medial and lateral laxity in intact human cadaver knees. J Bone Joint Surg Am 63:1257–1269

    CAS  PubMed  Google Scholar 

  8. Halinen J, Lindahl J, Hirvensalo E, Santavirta S (2006) Operative and nonoperative treatments of medial collateral ligament rupture with early anterior cruciate ligament reconstruction—A prospective randomized study. Am J Sports Med 34:1134–1140

    Article  PubMed  Google Scholar 

  9. Hara K, Niga S, Ikeda H et al (2008) Isolated anterior cruciate ligament reconstruction in patients with chronic anterior cruciate ligament insufficiency combined with grade II valgus laxity. Am J Sports Med 36:333–339

    Article  PubMed  Google Scholar 

  10. Hart JM, Blanchard BF, Hart JA et al (2009) Multiple ligament knee reconstruction clinical follow-up and gait analysis. Knee Surg Sport Traumatol Arthrosc 17:277–285

    Article  Google Scholar 

  11. Hillard-Sembell D, Daniel DM, Stone ML et al (1996) Combined injures of the anterior cruciate and medial collateral ligament of the knee. Effect of treatment on stability and function of the joint article. J Bone Joint Surg Am 78:169–176

    CAS  PubMed  Google Scholar 

  12. Jaureguito JW, Paulos LE (1996) Why graft fail. Clin Orthop Relat Res 325:25–41

    Article  PubMed  Google Scholar 

  13. Kim SJ, Lee DH, Kim TE, Choi NH (2008) Concomitant reconstruction of the medial collateral and posterior oblique ligaments for medial instability of the knee. J Bone Joint Surg Br 90:1323–1327

    Article  PubMed  Google Scholar 

  14. Koga H, Muneta T, Yagishita K et al (2012) Surgical management of grade 3 medial knee injuries combined with cruciate ligament injuries. Knee Surg Sports Traumatol Arthrosc 20:88–94

    Article  PubMed  Google Scholar 

  15. LaPrade RF, Engebretsen AH, Ly TV et al (2007) The anatomy of the medial part of the knee. J Bone Joint Surg Am 89:2000–2010

    Article  PubMed  Google Scholar 

  16. Laprade RF, Wijdicks CA (2012) Surgical technique: development of an anatomic medial knee reconstruction. Clin Orthop Relat Res 470:806–814

    Article  PubMed  Google Scholar 

  17. Lind M, Jakobsen BW, Lund B et al (2009) Anatomical reconstruction of the medial collateral ligament and posteromedial corner of the knee in patients with chronic medial collateral ligament instability. Am J Sports Med 37:1116–1122

    Article  PubMed  Google Scholar 

  18. Liu F, Yue B, Gadikota HR et al (2010) Morphology of the medial collateral ligament of the knee. J Orthop Surg Res 5:69

    Article  PubMed Central  PubMed  Google Scholar 

  19. Marx RG, Hetsroni I (2012) Surgical technique: medial collateral ligament reconstruction using Achilles allograft for combined knee ligament injury. Clin Orthop Relat Res 470:798–805

    Article  PubMed  Google Scholar 

  20. Osti L, Papalia R, Del Buono A et al (2010) Simultaneous surgical management of chronic grade-2 valgus instability of the knee and anterior cruciate ligament deficiency in athletes. Knee Surg Sports Traumatol Arthrosc 18:312–316

    Article  PubMed  Google Scholar 

  21. Peterson W, Loerch S, Schanz S et al (2008) The role of the posterior oblique ligament in controlling posterior tibial translation in the posterior cruciate ligament-deficient knee. Am J Sports Med 36:495–501

    Article  Google Scholar 

  22. Robins AJ, Newman AP, Burks BT (1993) Postoperative return of motion in anterior cruciate ligament and medial collateral ligament injures. The effect of medial collateral ligament rupture location. Am J Sports Med 21:20–25

    Article  CAS  PubMed  Google Scholar 

  23. Tibor LM, Marchant MH Jr, Taylor DC et al (2011) Management of medial-sided knee injuries, part 2: posteromedial corner. Am J Sports Med 39:1332–1340

    Article  PubMed  Google Scholar 

  24. Wijdicks CA, Ewart DT, Nuckley DJ et al (2010) Structural properties of the primary medial knee ligaments. Am J Sports Med 38:1638–1646

    Article  PubMed  Google Scholar 

  25. Wijdicks CA, Griffith CJ, Laprade RF et al (2009) Medial knee injury: part 2, load sharing between the posterior oblique ligament and superficial medial collateral ligament. Am J Sports Med 37:1771–1776

    Article  PubMed  Google Scholar 

  26. Yoshiya S, Kuroda R, Mizuno K et al (2005) Medial collateral ligament reconstruction using autogenous hamstring tendons: technique and results in initial cases. Am J Sports Med 33:1380–1385

    Article  PubMed  Google Scholar 

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The authors declare that they have no ethical/legal conflicts in relation to this article.

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Correspondence to Xizhuang Bai.

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Zhang, H., Bai, X., Sun, Y. et al. Tibial inlay reconstruction of the medial collateral ligament using Achilles tendon allograft for the treatment of medial instability of the knee. Knee Surg Sports Traumatol Arthrosc 22, 279–284 (2014). https://doi.org/10.1007/s00167-013-2382-6

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  • DOI: https://doi.org/10.1007/s00167-013-2382-6

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