# Acute Medial Collateral Ligament With Postero-Medial Complex Repair in Multiligament Knee Injuries Using a Novel “Double Shoelace Repair” Technique: 10-Year Clinical and Functional Outcomes

## TL;DR

A new surgical technique for knee ligament injuries shows excellent long-term results, with high recovery rates and minimal complications.

## Contribution

The novel 'double shoelace repair' technique for acute MCL and PMC injuries in multiligament knee injuries is introduced and evaluated.

## Key findings

- Lysholm and IKDC scores showed significant improvement after surgery.
- 90% of competitive athletes returned to preinjury activity levels.
- Low complication rates were observed with minimal long-term issues.

## Abstract

Background: Femoral-sided medial collateral ligament (MCL) avulsion and posteromedial corner (PMC) injury frequently occur together in the setting of multiligament knee injuries (MLKIs). Untreated PMC injuries are prone to develop residual valgus and rotatory instability. Early anatomic repair optimises outcomes. This study evaluates the long-term results of a novel “double shoelace repair” technique for acute MCL and PMC injuries performed with concurrent cruciate reconstructions.

Methods: A retrospective analysis was conducted on patients with MLKI who underwent acute (less than three weeks old) femoral-sided MCL and PMC repair using the double shoelace construct between 2011 and 2014. Concomitant anterior cruciate ligament (ACL)/posterior cruciate ligament (PCL) injuries were treated with single-stage all-inside reconstructions. Demographic data, injury patterns, stability, complications, and functional outcomes (Lysholm Knee Scoring Scale, International Knee Documentation Committee assessment, Tegner Activity Scale) were recorded. Minimum follow-up was 10 years. Statistical significance was set at p < 0.05.

Results: Forty-one patients (mean age 35.12 ± 11.64 years) were included. The most common injury pattern was ACL + MCL + PMC (78.05%). Mean time to surgery was 6.95 days, and mean follow-up was 12.43 years. Lysholm scores improved from 27.27 ± 9.4 to 92.8 ± 2.84 (p < 0.001) and IKDC scores from 37.2 ± 6.8 to 88.78 ± 4.91 (p < 0.001). The mean Tegner score at final follow-up was 4.54 ± 1.52. Of 10 competitive athletes, nine (90%) returned to preinjury level at a mean of 10.4 months. Complications were minimal: two failures (4.88%), no arthrofibrosis, and transient sensory deficits in 12.19%.

Conclusion: The double shoelace technique provides dependable restoration of medial stability and excellent long-term function in acute MCL + PMC injuries associated with MLKIs, with high return-to-sport rates and low complication rates. Further comparative studies are needed to refine indications.