title: Surgical Techniques for the Reconstruction of Medial Collateral Ligament and Posteromedial Corner Injuries of the Knee: A Systematic Review.
abstract: OBJECTIVE
  To systematically review reconstruction techniques of the medial collateral ligament (MCL) and associated medial structures of the knee (e.g., posterior oblique ligament).
  
  
  METHODS
  A systematic review of Medline/PubMed Database (1966 to November 2013), reference list scanning and citation searches of included articles, and manual searches of high-impact journals (2000 to July 2013) and conference proceedings (2009 to July 2013) were performed to identify publications describing MCL reconstruction techniques of the knee. Exclusion criteria included (1) MCL primary repair techniques or advancement procedures, (2) lack of clear description of MCL reconstruction technique, (3) animal models, (4) nonrelevant study design, (5) and foreign language articles without available translation.
  
  
  RESULTS
  After review of 4,600 references, 25 publications with 359 of 388 patients (92.5%) were isolated for analysis, including 18 single-bundle MCL and 10 double-bundle reconstruction techniques. Only 2 techniques were classified as anatomic reconstructions, and clinical and objective outcomes (n = 28; 100% <3 mm side-to-side difference [SSD]) were superior to those with nonanatomic reconstruction (n = 182; 79.1% <3 mm SSD) and tendon transfer techniques (n = 114; 52.6% <3 mm SSD).
  
  
  CONCLUSIONS
  This systematic review demonstrated that numerous medial reconstruction techniques have been used in the treatment of isolated and combined medial knee injuries in the existent literature. Many variations exist among reconstruction techniques and may differ by graft choices, method of fixation, number of bundles, tensioning protocol, and degree of anatomic restoration of medial and posteromedial corner knee restraints. Further studies are required to better ascertain the comparative clinical outcomes with anatomic, non-anatomic, and tendon transfer techniques for medial knee reconstruction.
  
  
  METHODS
  Level IV, systematic review of level IV studies and surgical techniques.
authors.affiliation: College of Medicine, Medical University of South Carolina, Charleston, South Carolina, U.S.A.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: DeLong
authors.affiliation: Department of Orthopaedic Surgery and Rehabilitation, William Beaumont Army Medical Center, El Paso, Texas, U.S.A.. Electronic address: brian.r.waterman@gmail.com.
authors.forename: Brian R
authors.initials: BR
authors.lastname: Waterman
mesh_terms: D006801:Humans; D007593:Joint Instability / Q000209:etiology / Q000601:surgery*; D007718:Knee Injuries / Q000150:complications / Q000601:surgery*; D017888:Medial Collateral Ligament, Knee / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D013709:Tendon Transfer / Q000379:methods