Osteotomy of the Femoral Lateral Collateral Ligament Insertion for a Tight Lateral Compartment in Complex Arthroscopic Knee Surgery

Background: In cases of complex arthroscopic knee surgery in the lateral compartment, such as performing lateral meniscus repair or transplantation, a tight lateral compartment can jeopardize the best possible care and could lead to iatrogenic cartilage injury. This technique shows a way to increase arthroscopic working space in a tight lateral compartment by performing an osteotomy of the femoral insertion of the lateral collateral ligament (LCL), utilizing a novel adjustable loop refixation technique. Indication: The femoral LCL insertion osteotomy can be performed if increased visualization and working space of the lateral compartment are needed during the complex arthroscopic knee surgery. Technique Description: After identification of the LCL femoral insertion, a 2-mm drill is passed through the LCL insertion to prepare for an anatomic reduction. The osteotomy is performed by taking a small bone plug together with the complete LCL insertion. Increased visualization and working space in the lateral compartment are obtained without damaging the intrinsic LCL structure. For reinsertion, the bone plug and proximal LCL is whipstitched with a high-strength suture and fixated to an adjustable loop Ultrabutton. The adjustable loop is shuttled through a predrilled 4.5-mm femoral tunnel and flipped on the medial side. The adjustable button is tensioned in 30° of flexion until the bone plug is anatomically reduced. Results: We present 1 patient who underwent a femoral LCL osteotomy during arthroscopic lateral meniscus allograft transplantation. The osteotomy healed without any issues, and there was no residual LCL laxity; which was confirmed with varus stress radiographs. Discussion/Conclusion: A femoral LCL insertion osteotomy can release a tight lateral compartment without damaging the intrinsic LCL structure. The adjustable loop fixation avoids the use of more traditional screw and washer fixation techniques, which tend to be more prominent and have the potential to back out. An osteotomy is more invasive than the “pie-crusting” technique of the medial collateral ligament for a tight medial compartment. However, it is required due to the poor intrinsic healing capacity of the LCL. Care should be taken to anatomically reduce the bone plug to avoid iatrogenic creation of LCL laxity. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication