Reconstruction of medial collateral ligament and posterior oblique ligament of the knee using anatomically routed semitendinosus transfer: a retrospective case series

Background: Double bundle reconstruction of superficial medial collateral (sMCL) and posterior oblique (POL) ligaments with a single femoral tunnel using distally based semitendinosus is a traditional procedure for management of medial knee ligament complex injuries. However, the transferred tendon was always routed in nonanatomical configuration. The author reports the clinical outcomes and complications in a reconstruction technique with anatomical graft routing method. Methods: Fourteen patients with International Knee Documentation Committee (IKDC) grade 3 or 4 valgus instability and anteromedial rotatory instability underwent reconstruction of sMCL and POL by anatomically routed semitendinosus tendon transfer. The average age of the patients was 36.6 yr. Medial-sided knee ligament injury was isolated in two patients and part of multiligament knee injury in 12 patients. The average duration between injury and surgery was 7 wk (range 2 to 25). Patients were evaluated preoperatively and at final follow-up. Results: After a median follow-up of 29.5 mo (range, 24 to 36), the mean Lysholm and IKDC subjective scores improved from 27 (2.95) and 46.8 (8.26) preoperatively to 87.6 (3.44) and 71.7 (3.68) at latest follow-up (P<0.05), respectively. Nine patients (64.3%) returned at a preinjury Tegner score level at final follow-up. Both medial and posteromedial laxity were significantly improved on physical examination (P<0.01). No patients had recurrent laxity of medial knee reconstruction or any concurrent cruciate ligament reconstructions. Conclusions: Reconstruction of sMCL and POL using anatomically routed semitendinosus transfer showed favorable clinical outcomes without recurrence of medial or anteromedial instability after midterm follow-up. Level of Evidence: Level IV.