Ligaments and tendons of the knee are subjected to large loads during sports and work related activities, and thus, are frequently injured. For the anterior cruciate ligament (ACL) and medial collateral ligament (MCL), there are over 100,000 and 50,000 annual tears, respectively, in the United States alone. As a torn ACL has limited healing potential, surgical reconstruction using autograft replacements, such as the bone-patellar tendon-bone (BPTB) as well as the quadrupled semitendinosus and gracilis tendons, are performed in a large number of patients to restore knee stability. In spite of the over 25 years of experience, knee extension deficits and many long term complications associated with the BPTB autograft, including the progression of osteoarthritis, are serious post-surgical problems. Additionally, there are complications associated with donor site morbidity, anterior knee pain, arthrofibrosis, and inferior biomechanical properties of the patellar tendon (PT). In the case of MCL injuries, functional treatment is sufficient for rapid tissue healing; however, the neo-MCL is known to have significantly inferior tissue quality compared to the intact MCL, and the remodeling process can take years. Thus, it presents an increased chance for reinjury.

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