Journal
ARTHROSCOPY-THE JOURNAL OF ARTHROSCOPIC AND RELATED SURGERY
Volume 24, Issue 4, Pages 486-489Publisher
W B SAUNDERS CO-ELSEVIER INC
DOI: 10.1016/j.arthro.2007.08.003
Keywords
achilles allograft; medial collateral ligament; posterior cruciate ligament
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We present a method for single-Achilles allograft medial collateral ligament (MCL) and posterior cruciate ligament (PCL) reconstruction that eliminates the risk of tunnel intersection, stiffens the construct, and maximizes utilization of allograft tissue. An Achilles tendon allograft is prepared with an 11 - to 12-mm bone plug with a gradual taper to 7 mm over approximately 15 cm. A transtibial PCL tunnel is created under fluoroscopic and arthroscopic guidance. The femoral tunnel is prepared in an outside-in fashion under direct arthroscopic visualization, originating at the anatomic origin of the MCL on the medial epicondyle and entering the joint at the anatomic origin of the anterolateral bundle of the PCL. The Achilles graft is pulled into the joint through the tibial tunnel and routed into the femoral tunnel so that the soft tissue exits at the medial epicondyle. The bone plug is fluoroscopically guided to the posterior aperture of the tibial tunnel and fixed with a bioabsorbable interference screw. The pretensioned graft is fixed in the femoral tunnel via interference screw fixation with the knee in 90 degrees of flexion. The isometric position of the MCL insertion is identified with a K-wire isometer, and the graft is fixed in place at this point by use of an interference screw or screw and washer.
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