Open Reconstruction of Fibular Collateral Ligament Rupture Using a Partial-Thickness Biceps Femoris Tendon Autograft

Fibular collateral ligament (FCL) injuries are uncommon incidents, with less favorable healing rates compared to medial collateral ligament injuries, often necessitating repair or reconstruction as the predominant treatment approach.

Using a partial-thickness biceps femoris tendon (PTBFT) autograft for FCL reconstruction or augmentation is a viable option for both acute and chronic FCL injuries, especially in patients unwilling to accept allograft tissue and in settings with limited access to allografts.

The fibular head attachments of the biceps femoris tendon (BFT), FCL, and popliteofibular ligament are inspected for injury. The biceps-iliotibial band (ITB) interval is opened, and the native FCL is assessed at its midsubstance for injury. The mid-aspect of the ITB was incised in line with its fibers, and the femoral insertion of FCL is localized. A 10-mm × 70-mm graft is harvested from the middle third of the BFT, preserving the distal insertion on the fibular head. Locking Krackow sutures are placed into the proximal end of the graft, which is passed under the ITB. A femoral tunnel is created at the FCL attachment site, and the graft is placed into the femoral tunnel and secured to the femur using an interference screw.

Postoperatively, the patient is instructed on foot-flat touch weightbearing with 2 crutches, on a knee immobilizer, for the first 2 weeks. Increasing weightbearing status and range of motion are expected in a stepwise manner. Return to sports is permitted after 6 to 9 months and depends on the presence of any additional injuries, strength, and functional recovery. There no studies available yet on clinical outcomes.

FCL reconstruction or augmentation utilizing a PTBFT autograft is an underused treatment option for patients with isolated FCL insufficiency or as part of multiligamentous injuries. This procedure offers advantages such as an anatomic reconstruction; single incision for both graft harvest and FCL reconstruction; shorter, cost-effective surgery with fewer implants used; and a safer approach with reduced risk of neurovascular structures due to lack of a fibular head tunnel. This is a valuable option in the limited source setting or in a patient not accepting of allografts.

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