2015 ISAKOS Biennial Congress ePoster #1137

Rectus Femoris Tendon-Bone Autograft for Isolated MCL and for Combined MCL with BPTB ACL Reconstruction

Iftach Hetsroni, MD, Associate Prof., Herzliya ISRAEL
Gideon Mann, MD, Prof., Kfar Saba ISRAEL
Orthopedic Department, Meir General Hospital, Kfar Saba, and Sackler Faculty of Medicine, Tel Aviv University , Kfar Saba, ISRAEL

FDA Status Not Applicable

Summary: Rectus Femoris tendon-bone autograft can be used for MCL reconstruction and reliably restore medial knee stability in isolated MCL and in combined MCL-ACL knee deficiencies

Abstract:

Objective

To present a surgical technique for medial collateral ligament (MCL) reconstruction that uses Rectus Femoris tendon-bone autograft, and to provide clinical outcomes.

Methods

After Grade III MCL laxity is confirmed, the Rectus Femoris tendon is dissected-out, creating a 15-cm long by 10-12-mm wide tendon with a 9*18-mm patellar bone plug. The Vastus Intermedius layer of the Quadriceps tendon is left intact. A guide-pin is inserted just posterior to the medial femoral epicondyle, and a 9*20-mm socket is reamed over the pin. A 2-cm incision is made at the distal tibial insertion of the MCL, located 6-cm distal to the joint line. The patella bone-plug is docked in the femoral socket and fixed with a 7*20-mm interference screw. The graft is then passed deep to layer I, advanced to the isometric insertion site on the tibia, and fixed on the tibia with a screw and a spiked washer with the knee at 20° flexion and slight varus stress. A 5.5-mm double-loaded anchor is added to the graft at 5-10-mm below the joint line. When concomitant autologous BPTB ACL reconstruction is performed in combined ACL-MCL instability scenario, the ACL graft is fixed initially, followed by MCL reconstruction and fixation. In this case, proximal and distal patellar plugs are limited to a length of 15-mm each, ensuring adequate bone bridge between the two harvest locations on the patella.

Results

Six patients (four men and two women) underwent MCL reconstruction using the described technique. Mean age at surgery was 25 years. Four patients had combined autologous BPTB ACL reconstruction with ipsilateral autologous Rectus Femoris tendon-bone MCL reconstruction, and two patients had isolated autologous Rectus Femoris tendon-bone MCL reconstruction. Mean followup was 24 months (range, 10-40 months). Mean IKDC-subjective score was 48 before surgery, and 85 at latest followup (p=0.01). Before reconstruction, all patients had Grade III MCL laxity. At latest followup, all patients regained normal symmetric Grade 0-1 MCL laxity. Less than 3mm side-to-side ACL laxity was recorded at followup when ACL reconstruction was concomitantly performed. No loss of range of knee motion or other postoperative complications were recorded.

Conclusions

Rectus Femoris tendon-bone autograft can be reliably used for MCL reconstruction. This technique reproduces anatomical insertions of the superficial MCL, is performed with minimal skin incisions on the medial side of the knee, and reproduces normal MCL laxity at followup.