· Surgical repair can be performed for acute or avulsion-type injuries.
o Laprade and Wijdicks (2012) technique:
§ an anatomic reconstruction of the proximal and distal divisions of the superficial MCL and the POL using two separate grafts
§ An anteromedial longitudinal incision beginning 4 centimeters medial to the patella and extending 8 centimeters distal to the joint line is utilized to expose both the femoral the distal tibial attachment sites of the superficial MCL.
§ sartorial fascia is incised to expose the gracilis and semitendinosus tendons
§ The semimembranosus tendon can be harvested for autograft based on surgeon preference
§ Tibial tunnels:
· First, a reconstruction tunnel is created for the superficial MCL’s distal insertion.
· Next, a reconstruction tunnel for the central arm of the POL is then placed just anterior to the direct arm attachment of the semimembranosus tendon.
§ Femoral tunnels:
· superficial MCL tunnel is placed slightly proximal and anterior to the medial epicondyle.
· femoral POL tunnel is placed approximately 8mm distal and 3mm anterior to the gastrocnemius tubercle
§ The femoral ends of the grafts are first fixed with interference screws.
§ POL graft is then placed into its tibial tunnel and tensioned in full extension and neutral rotation
§ The superficial MCL is weaved under the sartorial fascia and fixed in its tibia tunnel with the knee held in neutral rotation, 20 degrees of flexion, and a slight varus reduction force to ensure no medial compartment gapping
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