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Chronic anteromedial rotatory instability of the knee: technique and results of a near-anatomical reconstruction

Background Superficial and deep medial collateral ligament (MCL) together with the posterior oblique ligament (POL) works in harmony to control anteromedial rotatory instability (AMRI) throughout the knee range of motion (ROM). Associated anterior cruciate ligament (ACL) injury, the most common type of combined ligamentous knee injury, will worsen the instability in all directions, greatly compounding the challenge to the management plan. Hypothesis Near-anatomical reconstruction of both the ACL and the MCL will restore knee AMRI to normal with minimal ROM deficit. Patients and methods Twenty-five patients with chronic combined ACL and MCL injury (>3 months since injury) were included in this study. Anatomical ACL with percutaneous MCL-POL was performed and the patients were assessed at 2 years for knee stability, ROM, and complications. Results The mean subjective International Knee Documentation Committee score among the patients was 43.32 ± 7.58 (range 28–60) at the end of follow-up. The mean was 94.76 ± 3.7 (range 89–100) (P < 0.0001). Knee stability was restored to normal in 84% and to nearly normal in 16%. Conclusion Anatomical ACL with percutaneous MCL-POL reconstruction gives very good results in cases of chronic AMRI. This technique is associated with little morbidity and can be achieved through minimally invasive incisions.