Primary Repair of the Medial Collateral Ligament with a Double Row Suture Technique and Suture Tape Augmentation for Acute Tibial-Sided Injuries

Abstract

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.

Patellar Tendon Repair With Suture Tape Augmentation for Proximal Patellar Tendon Rupture

“…Moreover, the augmentation technique using suture tape with knotless anchors has become popular for various injuries, such as medial collateral, medial patellofemoral, and anterior talofibular ligament injuries. [11][12][13][14] The described surgical technique has some disadvantages (Table 2). First, suture tape augmentation is a synthetic augmentation.…”

Self-Tensioning Feature of Knotless Suture Anchor Provides Reproducible Knotless Fixation Independent of Initial Tension

“…Although the study of the properties of a specific anchor and suture construct may limit the generalizability of this result to other forms of fixation, we believe this is a strength, as the majority of the published literature has reported using the studied suture anchor for fixation of knotless suture tape augmentation constructs. 1 , 2 , 5 , 7 – 10 …”

“…1 In the majority of cases, the fixation of the suture tape is achieved by a knotless suture anchor (PEEK [polyetheretherketone] SwiveLock; Arthrex Inc). 1,2,5,[7][8][9][10] In the current literature, knotless fixation with this particular anchor has been shown to have less variable tension…”

“… 1 In the majority of cases, the fixation of the suture tape is achieved by a knotless suture anchor (PEEK [polyetheretherketone] SwiveLock; Arthrex Inc). 1 , 2 , 5 , 7 – 10 In the current literature, knotless fixation with this particular anchor has been shown to have less variable tension compared with knotted constructs; however, the amount and consistency of the achieved tension after primary fixation remain unclear. 3 The purpose of the current study was to determine whether initial tensioning of suture tape before fixation with a knotless suture anchor significantly affects the final tension of the suture tape reinforcement in a biomechanical model.…”

“… 18 With the goal of preventing rerupture, internal bracing using independent suture tape reinforcement is increasingly being used in soft tissue knee ligament surgery, including ACL reconstruction. 2 , 5 , 8 – 10 First described by Mackay et al, 12 the goal of the suture tape reinforcement is to act as a “safety belt” in a synergistic load-sharing manner, while avoiding stress shielding of the soft tissue graft. 14 This is particularly relevant to patients undergoing an accelerated postoperative rehabilitation program, in which the internal bracing of the ACL graft during the revascularization process is a potential benefit.…”