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

Anteromedial knee instability is a complex clinical problem, especially when combined with valgus instability. This type of instability often occurs with injuries to the superficial (sMCL) and deep (dMCL) medial collateral ligaments. In 55%-70% of cases, there is a combined dMCL lesion with distal sMCL lesion. These ligaments are the primary stabilizers against valgus stress and anteromedial rotational forces. Inadequately treating both the sMCL and the dMCL can lead to persistent instability and an increased risk of anterior cruciate ligament graft failure. Biomechanical studies confirm that restoring the anatomy of the sMCL and dMCL is necessary to control anteromedial rotational instability. Standard posteromedial techniques may not sufficiently treat external rotational laxity. Anteromedial reconstruction techniques, in particular, more accurately reproduce the natural kinematics of the knee. The refixation technique presented here uses 3 anchor points at the sMCL, dMCL, and anteromedial complex. Especially retensioning of the sMCL through a "fan out" effect is achieved. This method directly treats anteromedial and valgus instability. It can be performed as an isolated procedure or in combination with anterior cruciate ligament reconstruction. Current literature shows that anteromedial reconstructions, whether combined or isolated, reduce instability and protect anterior cruciate ligament grafts. Further long-term clinical studies are needed to optimize the technique and indications.