[Minimally invasive augmentation of the medial collateral ligament with autologous hamstring tendons in chronic knee instability].

OBJECTIVE

Medial collateral ligament reconstruction in chronic unstable knees.

INDICATIONS

Chronic instability of the medial collateral ligament (MCL) isolated or in combination with multiligament injuries.

CONTRAINDICATIONS

Refixable bony avulsions, limited range of motion, arthrofibrosis, severe valgus deformity, infections, critical soft tissue, lack of patient compliance and open growth plates.

SURGICAL TECHNIQUE

Harvesting of the contralateral semitendinosus tendon and preparation. Supine position with leg in electric leg holder. Oblique skin incision above the pes anserinus parallel to the tendons. Placement of drill hole distal to the tibial insertion of the hamstrings in the footprint of the MCL. Tapering and fixation of the transplant. Subfascial tunneling and femoral fixation of the transplant distally to the medial patellofemoral ligament (MPFL) origin in 30° flexion under fluoroscopic control. Tibial fixation of the dorsal portion of the transplant (POL) ventral to the semimembranosus tendon footprint in full extension.

POSTOPERATIVE MANAGEMENT

Limited weight bearing with 20 kg for 4-6 weeks, stabilizing brace with limited range of motion 0/0/90°.

RESULTS

A total of 9 patients with a median age of 39 (18-70) years received an augmentation of the MCL complex due to a chronic instability using the described technique. Follow-up examination was performed after 16 (11-56) months. All patients reported a stable knee. The median value of the Lysholm score at follow-up was 90 (72-96) points and the Tegner score prior to trauma was 4 (2-6) points and 3 (2-6) points during follow-up. No grade 2 or 3 instability could be observed during follow-up. There were no complications using the above mentioned technique.