Lateral Collateral Ligament Repair With Reconstruction Augmentation

Background: Lateral collateral ligament (LCL) injuries, especially with distal avulsions involving the biceps femoris tendon, cause significant knee instability. Prompt surgical repair is essential to restore stability and prevent long-term issues. Augmenting repairs with grafts, such as semitendinosus allografts, enhances durability. Indications: This technique is indicated for acute LCL injuries with distal avulsions. A 17-year-old male soccer player presented with right knee pain and instability following a direct medial contact injury. Physical examination revealed lateral knee tenderness and varus laxity, confirmed by magnetic resonance imaging and varus stress radiographs. Technique: A curvilinear incision was made at the lateral epicondyle, extending between Gerdy’s tubercle and the fibular head. The common peroneal nerve was protected. A fibular tunnel was created using a guide pin and reamer. An intramedullary anchor was placed in the fibula with fluoroscopic confirmation. The femoral tunnel was prepared, and a semitendinosus allograft was whipstitched with looped sutures, docked in the femoral socket, and secured with a bioabsorbable interference screw. The graft was passed through the fibular tunnel, and the LCL and biceps femoris tendon were repaired with sutures. The graft was then tensioned and fixed with an interference screw in the fibular tunnel, and excess graft was trimmed. Results: Postoperative evaluation showed significant improvement in knee stability with a firm endpoint and normal recoil on varus stress testing. The graft reinforced the repaired structures, enhancing overall knee stability. Discussion/Conclusion: Early surgical intervention for acute LCL injuries with distal avulsions is crucial for restoring knee stability. Augmentation with a semitendinosus allograft provides additional support, promoting better outcomes and reducing repair failure risks. This technique ensures anatomic restoration and facilitates early rehabilitation, aligning with current orthopaedic literature. The procedure is a reliable and effective method for treating complex LCL injuries, offering significant improvements in stability and function. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.