Semimembranosus Autograft Harvesting and Reconstruction for Knee Posteromedial Complex Laxity Using a "Romal Reins" Technique

This technical report presents semimembranosus tendon harvest and its use as an autograft in knee ligament reconstruction. The distal semimembranosus tendon is a robust and long tendon, which makes it a suitable autograft option with its distal insertions kept intact. It has multiple insertions onto the posteromedial corner of the tibia and the posteromedial ligament complex (PMC). Tensioning this tendon insertion results in tightening of the PMC and thus achieves posteromedial stability. Harvesting the tendon with its lateral third left intact with its muscular attachment retains its dynamic action. Using the medial two-thirds of the tendon as an autograft for PMC reconstruction with a "Romal Reins" concept restores joint stability. The graft is notably beneficial in cases of multiligament laxity where there may be a shortage of free autografts for PMC reconstruction. This technique tightens and reconstructs the major PMC stabilizing structures without requiring individual structural reconstructions. It reduces the need for multiple grafts, reconstructions, bone tunnels, and implants for managing PMC laxity. This technique of semimembranosus tendon graft harvest and PMC reconstruction is safe, simple, minimally invasive, and effective with the least risk of complications. It could possibly be a preferred graft and reconstruction technique for PMC reconstruction.