Quadriceps tendon free graft augmentation for a midsubstance tear of the medial collateral ligament during total knee arthroplasty

Abstract 

Primary repair of a disrupted midsubstance MCL during TKA can provide satisfactory stability. However, in cases with poor soft tissue quality or a gap between the ligament ends, primary repair may not be feasible. In these cases, we have used an augmented repair. The purpose of this study is to describe the technique of augmented repair using a quadriceps tendon free graft and present our experience of five patients.

A total of five patients underwent augmented repair of a transected MCL substance using a quadriceps tendon free graft. The patients were followed-up for a mean of 16 months.

Augmented repair of the transected MCL substance was successful in all five patients, with a mean additional surgery time of 17 min, no coronal instability, a mean Knee Society Score of 87.0±2.7 (range, 85 to 90), and a mean function score of 85.0±3.5 (range, 80 to 90). There were no complications associated with the extensor mechanism.

This data suggests that quadriceps tendon free graft augmentation might be a useful alternative for repairing midsubstance tears of the MCL in special situations, where the quality of the remaining tendon is poor, there is suspicion of stretching, and there is a small gap between both the repaired ligament ends resulting in late laxity.

Keywords: MCL injury, Quadriceps tendon, Total knee arthroplasty