Fig 5.

Tibial fixation of the left knee superficial medial collateral ligament (sMCL) and posterior oblique ligament (POL) allografts. (A) A 2.8-mm all-suture anchor (Q-FIX; Smith & Nephew) is placed at the previously identified proximal sMCL as well as at the POL attachments on the tibia. (B) If loosening of the staple at the distal sMCL insertion site is appreciated, the sMCL graft is secured with two 2.8-mm all-suture anchors. (C) The matching suture limbs of the two 2.8-mm all-suture anchors are passed from distal to proximal through the tendon in a Krakow fashion, tension is applied to the post limbs, the graft is reduced to the tibia, and suture limbs are tied. (D) The proximal tibial sMCL attachment is then secured using sutures from the previously placed anchor. Sutures are passed through the Achilles allograft in a mattress fashion and tied. (E) The POL graft is secured to the tibia with the suture limbs passed in a mattress fashion through the graft and tied with the knee in full extension while a varus force is applied. The free POL graft limb is folded on top of itself to produce a double-stranded reconstruction of the POL. A high-strength suture (no. 2 FiberWire; Arthrex) is used to secure the 2 folded limbs of the graft together and reinforce the posterior capsule.