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Short- to mid-term outcomes of anatomic MCL reconstruction with Achilles tendon allograft after multiligament knee injury



Multiple techniques have been described in the literature for reconstruction of the medial collateral ligament. The purpose of this study is to describe functional outcome, range of motion, and knee stability following anatomic MCL reconstruction utilizing an Achilles tendon bone allograft after multiligament knee injury.


A comprehensive search of a single-hospital multiligament knee injury (MLKI) procedural database was conducted to identify all patients that underwent reconstruction of the MCL utilizing an Achilles tendon bone allograft and with 2-year clinical follow-up. Medical charts were retrospectively reviewed to determine each patient’s knee dislocation (KD) grade, final range of motion, stability on clinical examination, and the incidence of complications and reoperations. KOOS, IKDC, and Marx scores were also collected.


Thirty-two knees in 32 patients (21 males and 11 females) with a mean age of 30 years (range 15–51) were followed for an average of 40 months (range 28–87 months) following MCL reconstruction with Achilles tendon bone allograft. For patients with multiligament knee injuries, there were 14 KD-I (11 ACL/MCL; 3 MCL/PCL; 1 MCL/ACL/LCL; 1 MCL/PCL/LCL), 12 KD 3-M, and 3 KD-IV. One patient underwent isolated revision MCL reconstruction. At final follow-up, clinically significant valgus laxity was observed in only 1 patient (3%). All patients were able to achieve full extension of the knee and the average flexion was 121.1 ± 19.6. The average IKDC score was 67.6 ± 19.9 (range 27.7–98.9), the average KOOS score 77.1 ± 16.8 (range 31–100). The average Marx score was 4.9 (range 0–16, SD 5.2). Thirty-one of 32 (96%) patients reported being satisfied with results of the surgery. Knee dislocation grades were significantly correlated with post-operative outcome measures.


In a series utilizing a modified Marx Achilles tendon, MCL reconstruction in the setting of MLKI demonstrated satisfactory clinical and functional outcomes, as well as patient satisfaction at short- to mid-term follow-up. Furthermore, knee dislocation grades were demonstrated to correlate with post-operative IKDC, KOOS, and Marx scores.

Level of evidence

Type IV.

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Correspondence to Bruce A. Levy.

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Conflict of interest

Michael Stuart: Consultant for Arthrex, receives royalties from Arthex, consultant for Smith and Nephew, receives research support from Biomet. Aaron Krych: Consultant for Arthrex. Bruce Levy: Consultant for Arthrex, received royalties from Arthrex, receives research support from Stryker. Ian Barrett, Nicholas Johnson, Ayoosh Pareek and Diane Dahm declare that they have no conflict of interest.

Ethical approval

The local institutional review board (IRB: Mayo Clinic, Rochester, MN) approved this study.

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No informed consent was applicable.

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This project has been approved by the Mayo Clinic IRB.

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Barrett, I.J., Krych, A.J., Pareek, A. et al. Short- to mid-term outcomes of anatomic MCL reconstruction with Achilles tendon allograft after multiligament knee injury. Knee Surg Sports Traumatol Arthrosc 26, 2952–2959 (2018).

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  • Medial collateral ligament
  • MCL reconstruction
  • Achilles tendon allograft
  • Reconstruction
  • Ligament reconstruction