Minimally-Invasive, Retensionable, Onlay Double-Bundle Medial Collateral Ligament Reconstruction

The superficial medial collateral ligament (sMCL) is the most injured knee ligament, and the most commonly coinjured ligament in anterior cruciate ligament tears. The technique's goal is to be less invasive while maintaining the hamstrings' function.

Surgical indications for this technique include isolated grade 3 injuries that fail nonoperative management and multiligament knee injuries that include the MCL.

Items needed for the double-bundle reconstruction technique include an anterior tibialis graft > 270 mm, C-Arm for visualization of radiographic landmarks, 2 knotless all-suture anchors, and an adjustable-loop suspensory fixation device. First, create a 3-4-cm incision over the distal tibial insertion of the sMCL, approximately 6 cm from the joint line. Then, split the hamstring fascia and identify the distal tibial insertion of the sMCL. Create a bleeding bed of bone at the anterior and posterior aspects of the distal tibial insertion of the sMCL. Place a knotless suture anchor at the anterior aspect of the distal tibial insertion of the sMCL and a knotless suture anchor at the posterior aspect of the distal tibial insertion of the sMCL. Proximally, identify LaPrade's radiographic femoral landmark for the origin of the sMCL. Make a 1-cm incision over this radiographic landmark. Then, place a spade-tip guide pin through the radiographic landmark, the femur, and the lateral cortex. This creates a femoral reconstruction socket. Then, shuttle the allograft into position from distal to proximal. Pull it into the femoral socket with the loop suspensory device. Then, secure it distally with 2 knotless suture anchors. Final tension is performed with the suspensory loop device with the assistance of arthroscopic viewing of the medial compartment.

This technique has been performed clinically by the senior author for the past 7 years. No reoperations nor revision surgeries have been required in the senior author's practice.

This minimally-invasive, retensionable, onlay double-bundle MCL reconstruction technique effectively restores medial knee stability and does not compromise the hamstrings' function to provide medial dynamic knee stability.

The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.