Chronic Medial Collateral Ligament Reconstruction

In cases in which the patient is first seen 3 weeks or more after the injury, it is probably too late to treat grade III MCL injuries successfully with either open primary repair or closed conservative management. In reviewing the literature, there are multiple ways to attempt to reconstruct the MCL. This usually means that there is no one procedure available that is always successful. In past years, the senior author reconstructed the MCL mainly by detaching its proximal end and either advancing it or countersinking it in an attempt to "retension" the

Figure 54-7 Higher magnification demonstrating a torn posterior capsule.

Figure 54-10 Repair of medial collateral ligament using Bunnell-Kessler suture configuration.

Retension Suture
Figure 54-8 Surgical repair of the posterior capsule with interrupted suture.

Figure 54-10 Repair of medial collateral ligament using Bunnell-Kessler suture configuration.

ligament. In addition, he would advance the posteromedial capsule anteriorly in an attempt to reestablish stability in full extension.

Recently, the senior author has used Achilles tendon allograft to reconstruct the MCL (Fig. 54-11). The allograft dimensions are similar to the MCL with the ACL length being greater. The femoral attachment site receives the calcaneal bone (10- to 12-

mm plug) with interference screw. The tibial attachment site is sutured over a post and/or biodegradable interference screws are used to achieve fixation via a transtibial tunnel (Fig. 54-12). In addition, a posteromedial capsular advancement is performed, but care is taken following each suture to ensure the ability to achieve full extension, thus preventing a situation in which the advancement "captures" the knee.

Medial Collateral Ligament Repair
Figure 54-12 Postoperative radiograph demonstrating femoral and tibial fixation of Achilles tendon allograft used for reconstruction of a chronic medial collateral ligament-deficient knee.

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Cure Tennis Elbow Without Surgery

Cure Tennis Elbow Without Surgery

Everything you wanted to know about. How To Cure Tennis Elbow. Are you an athlete who suffers from tennis elbow? Contrary to popular opinion, most people who suffer from tennis elbow do not even play tennis. They get this condition, which is a torn tendon in the elbow, from the strain of using the same motions with the arm, repeatedly. If you have tennis elbow, you understand how the pain can disrupt your day.

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