title: Surgical technique: medial collateral ligament reconstruction using Achilles allograft for combined knee ligament injury.
abstract: BACKGROUND
  Previous approaches for medial collateral ligament (MCL) reconstruction have been associated with extensive exposure, risk of donor site morbidity with autografts, loss of motion, nonanatomic graft placement, and technical complexity with double-bundle constructs. Therefore, we implemented a technique that uses Achilles allograft, small incisions, and anatomic insertions to reconstruct the MCL.
  
  
  METHODS
  The MCL femoral insertion was identified, and a socket reamed over a guide pin. The Achilles bone plug was fixed in the socket and the tendon passed distally under the skin and fixed on the tibia, creating isometric reconstruction.
  
  
  METHODS
  We evaluated 14 patients who had this MCL reconstruction. We determined range of knee motion, knee ligament laxity, functional outcome scores (International Knee Documentation Committee [IKDC]-subjective, Lysholm, Knee injury and Osteoarthritis Outcome Score [KOOS]), and activity level scores (Tegner, Marx). Followup range was 24 to 61 months.
  
  
  RESULTS
  Knee motion was maintained in 12 cases. Grade 0-1 + valgus stability was obtained in all 14 cases. In cases of MCL with primary ACL reconstruction, IKDC-subjective, Lysholm, and KOOS-sports scores were 91 ± 6, 92 ± 6, and 93 ± 12, respectively, and return to preinjury activity levels was achieved. In cases of MCL with revision ACL reconstruction, function was inferior, and patients did not return to their preinjury activity levels.
  
  
  CONCLUSIONS
  This technique uses allograft that provides bone-to-bone healing on the femur, requires small incisions, and creates isometric reconstruction. When performed with a cruciate reconstruction, knee stability can be restored at 2 to 5 years followup. In patients with MCL with primary ACL reconstruction, return to preinjury activity level in recreational athletes can be achieved.
authors.affiliation: Hospital for Special Surgery, Weill Medical College of Cornell University, 535 East 70th Street, New York, NY 10021, USA. MarxR@hss.edu
authors.forename: Robert G
authors.initials: RG
authors.lastname: Marx
authors.forename: Iftach
authors.initials: I
authors.lastname: Hetsroni
mesh_terms: D000125:Achilles Tendon / Q000637:transplantation*; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology; D017888:Medial Collateral Ligament, Knee / Q000293:injuries* / Q000601:surgery*; D019637:Orthopedic Procedures / Q000379:methods*; D016119:Posterior Cruciate Ligament / Q000293:injuries / Q000601:surgery; D016059:Range of Motion, Articular; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013536:Suture Techniques; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D014945:Wound Healing