2017 ISAKOS Biennial Congress ePoster #1813

 

Staged Anatomical Reconstruction Of Mcl Using Achilles Allograft, A Modification To Marx’S Technique

Hamidreza Yazdi, MD, Tehran IRAN, ISLAMIC REPUBLIC OF
John Y Kwon, MD, Boston UNITED STATES
Ara Nazarian, PhD, Boston, MA UNITED STATES
Mohammad Ghorbanhoseini, MD, Boston UNITED STATES

Iran university of medical sience, Tehran, IRAN, ISLAMIC REPUBLIC OF

FDA Status Not Applicable

Summary

Staged MCL reconstruction with modified Marx technique have good short term results

Abstract

Background

Medial collateral ligament (MCL) is the primary stabilizer of the knee that provides resistance against valgus deforming forces. Superficial MCL is the largest structure of the medial part of the knee. According to LaPrade and Brantigan, it has proximal and distal attachments on the tibia.
Most patients who sustain MCL injuries regain their activity level with nonoperative treatment, but in some severe cases, especially those with multiple ligament injuries, and those with isolated symptomatic chronic MCL laxity ,may require operative treatment. Marx et al. described the latest technique for reconstruction of MCL. They used Achilles tendon allografts and reconstructed the MCL at the same time as the cruciates . While good results have been generated using the Marx technique, some issues have been observed with the technique. For instance, the allografts don’t stay in contact with the tibial bone proximally. Also, patients have had complaints from the metallic hardware underneath the skin. Another issue has been the loss of ROM in some patients.The aim of this study was to modify this technique by using anchor sutures instead of metallic hardware and to fix the graft on proximal of tibia.
Material:We enrolled 11 patients and repaired their ligaments according to our technique after obtaining consent.

Methods

We used Achilles tendon allograft without a bone block attached to it. We fixed the allograft on the proximal and distal attachment footprints of the superficial MCL and used 3 suture anchors for that purpose, 2 sutures on the distal attachment footprint and one on the proximal. Also for preventing loss of knee ROM we reconstructed MCL and other ligaments in 2 separate stages.At the last follow up we evaluated the range of knee motion, knee ligament laxity and functional outcome scores, subjective International Knee Documentation Committee [IKDC] and Lysholm score. Follow up range was from 12 to 27 months.

Results

Knee motion was maintained in all cases. Two cases demonstrated 1+ valgus instability at 30 degree of knee flexion. Both were treated for combined MCL and PCL tear, the rest were completely stable. Average IKDC-subjective score was 93 ± 4 and average Lysholm score was 92 ± 3. All patients were completely satisfied and returned to their previous level of activity.

Discussion

In the modified Marx technique, we reconstructed the superficial MCL closer to its anatomical construct by attaching the allograft on the proximal and distal footprints of the superficial MCL. This resulted in better adhesion of allograft onto the bone, kept the allograft in complete contact with the tibial bone and completely restored the knee stability. By not using metallic hardware in the proximal medial side of the leg, patients didn’t have any complaints and the need for second surgery to remove the hardware was avoided. Also reconstructing the ligaments in 2 stages helped to better preserve the knee motion.The open technique also permit PM corner repair if needed.

Conclusions

Staged MCL reconstruction with modified Marx technique have good short term results .