Reconstruction of Superficial Medial Collateral Ligament: Modified Danish Technique with Dual Adjustable Loop Suspensory Fixation

Injury to the superficial medial collateral ligament (MCL) is treated conservatively for low-grade injury and with surgery for high-grade injury, especially in association with cruciate ligament injury. Acute injuries are treated with MCL repair, and chronic injury requires reconstruction. Anatomic MCL reconstruction can be done using free allograft or autograft and fixed using screws or suspensory fixation. We describe here an anatomic technique that is a modification of a Danish technique in which we reroute the semitendinosus, keeping its tibial attachment intact. The semitendinosus is rerouted anatomically in the tibial tunnel, and a graft is then passed anatomically in the femoral tunnel. The graft is fixed in both tunnels with adjustable loop suspensory fixation, which gives the unique advantage of controlled tensioning of the graft for MCL reconstruction. In this technique further re-tensioning is possible if the knee is unstable in valgus stress, even after final fixation.