Comprehensive Medial Knee Four-Arm Reconstruction to Address Complex Instability With Hamstring Autograft

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Knee Ligament Reconstruction

Background:

• Medial knee ligament injuries are complex, multiplanar lesions.
• These injuries can cause various instabilities including anteromedial rotatory, anteromedial, posteromedial, and posteromedial rotatory instability, alongside post-traumatic medial asymmetric hyperextension.

Purpose of the Study:

• To describe a surgical technique for comprehensively addressing all six types of medial knee instability.
• To reconstruct the medial ligamentous complex from anteromedial to posteromedial aspects.

Main Methods:

• A surgical technique utilizing four reconstruction arms with independent fixation.
• Two arms are created from a pedunculated semitendinosus autograft.
• Two arms are created from a free gracilis autograft.

Main Results:

• The technique reconstructs the medial ligamentous complex, addressing the anteromedial capsule, anterior oblique ligament, deep medial collateral ligament, superficial medial collateral ligament, posterior oblique ligament, and posteromedial capsule.
• The described method extensively addresses all six identified types of medial knee instability.

Conclusions:

• This four-arm reconstruction technique provides a comprehensive solution for complex medial knee ligament injuries.
• The independent fixation of graft arms allows for tailored reconstruction based on specific injury patterns.