Surgical approach to chronic medial injury

Of the all the ligaments in the knee, the medial sided structures are the most commonly injured. The medial stabilizers of the knee consist of the superficial medial collateral ligament, the deep medial collateral ligament, and the posterior oblique ligament. Nonoperative treatment mainly consists of early range of motion, bracing, and guarded weight bearing. In a subset of the acutely injured, operative repair is indicated. However, the large majority of medial sided knee injuries are successfully treated nonoperatively. In patients with Grade III injuries who are initially treated by nonoperative means but continue to show valgus instability and are clinically symptomatic, reconstruction is indicated. The senior author’s preferred technique for reconstruction of chronic medial instability is presented here in this chapter. The technique is a double graft technique reconstructing the native anatomy of the superficial medial collateral ligament and the posterior oblique ligament. Special attention is paid to the superficial medial collateral ligament as it has two tibial insertions. The proximal tibial attachment is a soft tissue restraint that is recreated with a suture anchor. Following this technique creates a reconstruction that most closely resembles the patient’s native anatomy restoring full function and relieving symptoms.