The management of medial collateral ligament (MCL) injuries has evolved during the past 30 years. Most heal reliably with conservative management. The treatment of MCL sprains with concomitant other ligamentous injuries continues to be controversial. Surgical management of chronic laxity of the medial structures can be quite difficult, and therefore anatomic repair of the medial support structures in the acute setting is preferred when indicated. Complete avulsion of the superficial and deep MCL from the tibia with disruption of the meniscal coronary ligament have a poor prognosis with non-operative treatment and may be optimally managed with acute surgical repair for improved valgus stability. A recent review demonstrated that there is a role for primary MCL repair for select patients. This technique addresses complete avulsions from the tibia, using multiple anchors for anatomic reattachment of the deep and superficial MCL, SutureBridge construct to enhance footprint compression, and suture tape to augment the MCL repair. Advantages of this technique include utilization of suture tape augmentation to allow for early range of motion, maintenance of the native MCL to preserve proprioception, and repair in the acute setting for faster recovery.

Highlights Distal fibula resection is a procedure that has been described as early as 1938 for the treatment of neoplastic lesions. Medial instability of the elbow can be traced back to the literature as far as 1946. The described technique can preserve long-term tibiotalar congruity and stability, allowing these patients to return to near normal function.

The direct anterior approach for total hip arthroplasty has grown in popularity over the last decade. Incision for this approach is often based on a standardized distance from the anterior superior iliac spine. Despite this method, wound complications remain a known complication during direct anterior approach. We describe a simple and reproducible technique using fluoroscopy to identify the incision during direct anterior total hip arthroplasty. This method allows for accurate placement of incision while adding only a minimal amount of time to the procedure. Using this technique helps minimize proximal skin maceration and lessens the need for extension of incision intraoperatively.