Distal Medial Collateral Ligament Repair With Suture Augmentation

Background: Distal medial collateral ligament (MCL) injuries are less common and have worse healing potential than proximal MCL injuries. The purpose of this video is to demonstrate the surgical technique of distal MCL repair with suture augmentation. Indications: The patient is a 17-year-old man who sustained a distal MCL injury and medial meniscocapsular junction tear while playing soccer. He was indicated for surgical management due to a complete distal MCL tear with symptomatic instability and concomitant medial meniscocapsular injury. Technique Description: The patient was placed in a supine position, and the bilateral knee was examined. Arthroscopic evaluation demonstrated a medial meniscocapsular junction tear, which was treated with a series of all-inside, horizontal mattress sutures. The proximal attachment of the MCL was identified proximally and posteriorly to the medial epicondyle under fluoroscopic imaging. The deep and superficial MCL attachments on the tibia were marked 1 and 6 cm distal to the medial joint line, respectively. After dissection of the pes anserine and distal MCL, a 1.8-mm knotless, all-suture anchor was inserted into the proximal attachment site of the MCL, and a fiber tape was passed through the anchor and folded to create 2 limbs. Two 1.8-mm knotless, all-suture anchors were inserted anterior and posterior to the native deep MCL, creating a mattress construct. The 2 limbs of the fiber tape were passed under the pes anserine and secured to the tibia with a 4.75-mm biocomposite knotless anchor with the knee positioned in neutral rotation, 30° of knee flexion, and varus stress. Results: The patient presented had full range of motion and stability compared with the contralateral extremity at 3 months postoperatively. Strength testing at 6 months demonstrated >95% strength in his proximal thigh musculature compared with the contralateral extremity. He was returned to sports without limitations at 6 months postoperatively. Discussion/Conclusion: Complete distal MCL injuries with instability and concomitant meniscal tears may be indicated for surgery, and arthroscopic medial meniscal repair with distal MCL repair with suture augmentation is a viable and replicable surgical treatment for this condition. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.