Medial Collateral Ligament Reconstruction using Partial Thickness Quadriceps Tendon-Bone Autograft for Isolated- and for Combined Knee Instability

Background: Previous reports describing autologous MCL reconstruction used exclusively the hamstrings tendons. With the disadvantage of harvesting hamstrings restraints in the already medially-unstable knee, we have developed a technique for MCL reconstruction which uses partial thickness Quadriceps tendon-bone autograft. The purpose was to present the technique and report minimum 2-year outcomes.

Methods: Patients who had MCL reconstruction using novel autologous partial thickness Quadriceps tendon-bone technique for MCL reconstruction with minimum 2 year follow-up were reviewed. Prospectively collected outcome data included IKDC-subjective score, Tegner and Marx activity level scores. At latest follow-up, side-to-side medial laxity differences were measured on stress radiographs with a Telos device, and side-to-side anterior laxity differences were measured with a KT-1000 device.

Results: Six consecutive patients, of whom four had combined MCL-ACL reconstruction and two had isolated MCL reconstruction, were reviewed. Mean age was 24 years (range, 22-26). Mean follow-up was 34 months (range, 24-55). IKDC-subjective score improved from 47 ± 11 before surgery to 89 ± 9 at latest follow-up (p < 0.01). Tegner activity level score was median 7.5 (range, 4-10) before the injury and 8 (range, 4-10) at latest follow-up. Marx score was median 14 (range 0-16) before the injury and 12 (range, 0-16) at latest follow-up. Telos valgus stress views at latest follow-up demonstrated side-to-side medial laxity difference between 0 and 2-mm. KT-1000 side-to-side anterior knee laxity difference was between (-1) and 2-mm.

Conclusion: Using partial thickness Quadriceps tendon-bone autograft for MCL reconstruction effectively restored medial knee stability in isolated MCL- and in combined MCL-ACL unstable knees. This technique may be of particular value when non-irradiated allograft is not available for MCL reconstruction and when harvesting medial knee restraints (i.e. semitendinosus) is wished to be avoided.