Surgical Innovation
Knee MCL Reconstruction
Dr. Marx has developed a technique for medial collateral ligament (MCL) reconstruction. Previous techniques often involved risks related to donor site morbidity from harvesting tissue and complications such as non-anatomic graft placement and loss of knee motion. To address these issues, Dr. Marx pioneered a refined technique that uses Achilles allograft (from a donor), small incisions, and anatomic insertions to reconstruct the MCL.
In a series of patients, the use of Achilles allograft promotes efficient healing, and the technique’s focus on isometric reconstruction ensures stability and functional recovery. For patients with MCL and primary ACL reconstruction, return to preinjury activity level was achieved.
If you’d like to learn more about this technique, please refer to the complete manuscript here.
Knee Posterolateral Corner Reconstruction with Achilles Tendon Allograft
Dr. Marx and his collaborators developed a technique for fibular collateral ligament posterolateral corner (PLC) reconstruction with a single Achilles tendon allograft construct. The anatomy of the PLC is complex, and the three primary static stabilizers are the fibular collateral ligament, the popliteofibular ligament (PFL), the popliteus tendon and the posterolateral capsule. It is the combined effect of these anatomic structures that provides the varus and external rotation stability necessary for knee function. Dr. Marx and his collaborators developed a reconstructive technique that is less complex than others and does not require the creation of a tibial tunnel and additional graft passage. This technique uses a single Achilles tendon allograft to reconstruct the FCL, the popliteus tendon, and the PFL.
If you’d like to learn more about this technique, please refer to the complete manuscript here.
Knee Posterolateral Corner Reconstruction with Double Femoral Fixation
Expanding on his previous work on posterolateral corner reconstructions, Dr. Marx and his collaborators also published a new surgical technique that uses adjustable loop cortical suspensory fixation implants for initial femoral fixation of the popliteus and the fibular collateral ligament grafts.
Residual posterolateral corner instability or failure after reconstructive surgery has been reported in 6% to 9.4% of surgical reconstruction cases. This new technique allows for individual tensioning of the grafts prior to definitive fixation with an interference screw, therefore limiting any residual creep and allowing for more secure, double femoral fixation of the graft.
If you’d like to learn more about this technique, please refer to the complete manuscript here.
Combined ACL and PLC Reconstructions with LET
Dr. Marx developed a new technique for adding lateral extra-articular tenodesis to anterior cruciate ligament (ACL) and posterolateral corner reconstructions. Combined ACL and PLC injuries are associated with a high degree of rotational instability and have a greater risk of ACL graft re-rupture. In these cases, the addition of a lateral extra-articular tenodesis, or LET, may reduce the risk of ACL graft injury without substantially increasing the overall procedure time or risks. Many recent studies have demonstrated how the addition of an LET to an isolated ACL reconstruction can reduce rates of ACL graft failure and rotatory laxity.
After surgery, patients are placed in a knee brace locked in full extension for two weeks. The patient is typically restricted to toe touch weight bearing for two weeks. Then after two weeks, the patient will transition to partial weight bearing and begin working on their range of motion. At four weeks post-op, patients may begin weight bearing as tolerated and advance physical therapy. For 9 to 12 weeks post-op the patient will wear the knee brace to protect the reconstructions.
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