Table 1.

Pearls and pitfalls

Pearls

•Coordinated discussion with an arthroplasty surgeon to discuss risks, benefits, and patient goals before proceeding with conversion to a more constrained prosthesis

•Evaluation by a sports medicine surgeon for posteromedial corner reconstruction should revolve around discussion based on patient age, bone quality, and activity level

•Examination of the knee under anesthesia in full extension and 30° of flexion to identify damage to posteromedial corner or isolated medial collateral ligament (MCL) injury

•The more proximal superficial medial collateral ligament (sMCL) tibial insertion is identified using the semimembranosus as an anatomic landmark

•Confirmation and measurement of adequate sMCL graft length to ensure proper valgus restraint

•The posterior oblique ligament (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

Pitfalls

•Less than sufficient tibial fixation of graft limbs in the setting of osteoporotic bone

•If loosening of the Richards staple in the proximal tibial bone is appreciated, the decision should be made to secure the sMCL graft with two 2.8-mm all-suture anchors, which should always be available in the operating room

•Potential for tunnel convergence or contact with the femoral total knee arthroplasty prosthesis if femoral sMCL and POL tunnels are not positioned appropriately

•Familiarity with medial knee anatomy is paramount to successful completion of an anatomic reconstruction of the posteromedial knee