Single-Row Repair in Chronic Medial Collateral Ligament Insufficiency

Medial collateral ligament (MCL) is the most commonly injured ligament of the knee. Acute Grade III MCL injuries can be managed conservatively except bony avulsion, intra-articular entrapment and Stener lesion, which requires surgical treatment by repair with or without augmentation. Chronic MCL injuries are treated surgically with various reconstruction techniques that are well established in the literature, which requires use of autograft or allograft and multiple tunnel placement with multiple implants for graft fixation. These techniques possess higher chances of tunnel convergence and hardware-related complications, further increasing surgery cost, especially for multi ligament injuries. Finally, all these MCL reconstruction surgeries are technically challenging. Here, we propose our technique of single-row repair in cases of chronic femoral side MCL insufficiency with grade III valgus laxity. This technique reattaches the torn ligament at its near anatomical attachment site using a single, double-loaded 5.5-mm suture anchor. This technique preserves and uses the native MCL, requiring no separate graft and no tunnel preparation. Hence, no graft site morbidity and tunnel-related complications, along with maintenance of proprioception. It is a cost-effective, reproducible, and technically simple procedure with good functional outcome.