Modified Refixation Technique of Distal Deep and Superficial Medial Collateral Ligament Injuries

Area of Science:

• Orthopedic Surgery
• Knee Biomechanics
• Sports Medicine

Background:

• Anteromedial knee instability, frequently combined with valgus instability, often involves injuries to the superficial (sMCL) and deep (dMCL) medial collateral ligaments.
• Combined dMCL and distal sMCL lesions occur in 55%-70% of cases, compromising stability against valgus stress and anteromedial rotational forces.
• Inadequate treatment of these ligament injuries can lead to persistent instability and increased risk of anterior cruciate ligament (ACL) graft failure.

Purpose of the Study:

• To present a novel refixation technique for anteromedial knee instability.
• To evaluate the technique's ability to restore knee kinematics and stability.
• To assess its efficacy as an isolated procedure or in conjunction with ACL reconstruction.

Main Methods:

• A refixation technique utilizing three anchor points: sMCL, dMCL, and anteromedial complex.
• Special emphasis on retensioning the sMCL via a "fan out" effect.
• Application as an isolated procedure or combined with ACL reconstruction.

Main Results:

• The technique directly addresses anteromedial and valgus instability.
• It accurately reproduces natural knee kinematics, improving rotational control.
• Literature suggests anteromedial reconstructions reduce instability and protect ACL grafts.

Conclusions:

• The presented refixation technique offers a viable solution for anteromedial knee instability.
• It effectively manages valgus and rotational instability by restoring ligament anatomy.
• Further long-term clinical studies are warranted to optimize technique and indications.