Collateral Ligament Injury

Collateral ligament tears and most knee ligament injuries involve a single ligament, but when a significant high energy force is placed on the knee, multiple ligaments can be affected. Depending on the location (medial or lateral) of the collateral ligament tear and whether the injury is acute or chronic the decision to repair or reconstruct can be confirmed through a careful clinical exam. The Collateral Ligament Reconstruction Set pioneered by Arthrex and surgeon consultants has been specifically designed to improve the safety, accuracy, and reproducibility for when the decision is made to repair and/or reconstruct these injuries around the outside of the knee.

Medial Collateral Ligament (MCL) Repair

Certain MCL injuries, including femoral and tibial avulsion injuries, such as Stener lesions, are more amenable to repair than others.¹
Using FiberTape® suture for the InternalBrace™ technique for MCL repair has been shown to provide additional stabilization compared to an MCL repair using only suture.² Adding the InternalBrace technique to an MCL repair may result in lower failure rates and less residual laxity post-op as well as shorter immobilization times and faster return to play.² FiberTape sutures have been used for more than 15 years in more than 4 million cases, including tendon and ligament-bridging repairs.
^The^Internal^{Brace surgical technique is intended only to support the primary repair and is not intended as a replacement for the standard of care using biologic augmentation in a primary repair. The}^Internal^{Brace surgical technique is intended only for soft-tissue-to-bone fixation and is not cleared for bone-to-bone fixation.}
^References
^{1. Shultz CL, Poehlein E, Morriss NJ, et al. Nonoperative management, repair, or reconstruction of the medial collateral ligament in combined anterior cruciate and medial collateral ligament injuries-which is best? a systematic review and meta-analysis.}^{Am J Sports Med.}^{2024;52(2):522-534. doi:10.1177/03635465231153157}
^{2. van Eck CF, Nakamura T, Price T, Linde M, Smolinski P. Suture tape augmentation improves laxity of MCL repair in the ACL reconstructed knee.}^{Knee Surg Sports Traumatol Arthrosc}^{. 2021;29(8):2545-2552. doi:10.1007/s00167-020-06386-7}

Medial Collateral Ligament (MCL) Reconstruction

MCL reconstruction is typically performed when the MCL is severely injured or in cases of chronic MCL laxity. During an MCL reconstruction, autograft or allograft tissue is used to reconstruct the injured ligament. Graft-fixation technology for MCL reconstruction has evolved from staples, posts and washers, and interference screws to less invasive and easier-to-use suspensory fixation, including the TightRope® implant, and
all-suture anchor technology, such as the Knee FiberTak® anchor.
Adding the InternalBrace™ technique to an MCL repair may result in lower failure rates and less residual laxity post-op as well as shorter immobilization times and faster return to play.¹ Additionally, FiberTape® suture has been used for more than 15 years in more than 4 million cases, including tendon and ligament-bridging repairs.
^The^Internal^{Brace surgical technique is intended only to support the primary repair and is not intended as a replacement for the standard of care using biologic augmentation in a primary repair. The}^Internal^{Brace surgical technique is intended only for soft-tissue-to-bone fixation and is not cleared for bone-to-bone fixation.}
^Reference
^{1. van Eck CF, Nakamura T, Price T, Linde M, Smolinski P. Suture tape augmentation improves laxity of MCL repair in the ACL reconstructed knee.}^{Knee Surg Sports Traumatol Arthrosc}^{. 2021;29(8):2545-2552. doi:10.1007/s00167-020-06386-7}

Lateral Collateral Ligament (LCL) and Posterolateral Corner (PLC) Reconstruction

For more than a decade, Arthrex has offered multiple collateral ligament reconstruction techniques, ranging from socket- and tunnel-based aperture fixation with FastThread™ interference screws to suspensory fixation using TightRope® technology.

The newest addition to our anchor portfolio, Knee FiberTak® anchors allow surgeons to perform minimally invasive collateral ligament reconstruction techniques to restore stability while preserving native anatomy. This versatile line supports both hybrid and all-onlay reconstruction, using both knotted and knotless SutureTape technology in conjunction with the InternalBrace™ technique.
^The^Internal^{Brace surgical technique is intended only to augment the primary repair/reconstruction by expanding the area of tissue approximation during the healing period and is not intended as a replacement for the native ligament. The}^Internal^{Brace technique is for use during soft tissue-to-bone fixation procedures and is not cleared for bone-to-bone fixation.}

Anatomic Collateral Ligament Reconstruction

Once the minimally invasive or open incision is made and proper soft-tissue windows are established, use the fibular, tibial, and/or femoral collateral marking hooks for anatomic precision and osseous measurements when drilling the appropriate reconstruction tunnels. Using the femoral collateral marking hook with the parallel drill guide will increase anatomic femoral drilling efficiency by significantly reducing convergent tunnels and allowing for accurate guide pin placement at multiple incremental distances. During tunnel creation, use the spooned ends of the collateral ligament retractor to retract the neurovascular structures and the collateral ligament rasp to chamfer the aperture of the completed reconstruction tunnels. Then use FiberWire® or FiberStick™ suture to pass the prepared grafts and tension to the desired position prior to graft fixation.

Collateral Ligament Graft Fixation

Multiple collateral ligament reconstruction techniques, from aperture fixation using the BioComposite SwiveLock® tenodesis system with biocomposite interference screws to suspensory fixation using TightRope® technology, are available.
FiberTak® soft anchors and biocomposite suture anchors, which come preloaded with needles, are part of a comprehensive line of anchor fixation devices supporting primary or hybrid collateral ligament repair and reconstruction techniques.