Medial Collateral Ligament Reconstruction
Medial collateral ligament (MCL) is one of the four major ligaments of the knee that connects the femur (thigh bone) to the tibia (shin bone) and is present on the inside of the knee joint. This ligament helps stabilize the knee. An injury to the MCL may occur as a result of direct impact to the knee. An MCL injury can result in a minor stretch (sprain) or a partial or complete tear of the ligament. The most common symptoms following an MCL injury include pain, swelling, and joint instability. If the overall stability of the knee is intact, Dr. Patel may recommend non-surgical methods including physical therapy, and bracing. Surgical reconstruction is recommended for MCL tears which fail to heal or those associated with other ligament injuries. MCL reconstruction is a minimally invasive technique that involves use of a tendon graft to reconstruct the injured MCL.
Indications and Contraindications
Medial collateral ligament reconstruction is indicated in patients with chronic MCL instability despite appropriate nonsurgical treatment.
An MCL injury can be diagnosed with a thorough physical examination of the knee and diagnostic imaging tests such as X-rays, arthroscopy, and MRI scans. X-rays may help rule out any fractures. In addition, Dr. Patel will often perform valgus stress test to check for the stability of MCL. In this test, pressure is applied on the outside surface of the knee with the knee in full extension and when bent approximately at 30°, excessive laxity is indicative of medial collateral ligament injury; the opposite knee is typically used as a reference.
Medial Collateral Ligament Reconstruction – Procedure
The procedure is performed under general anesthesia. Arthroscopic examination of the knee is performed to rule out any associated injuries including anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) tears.
The surgical procedure of medial collateral ligament reconstruction involves the following steps:
- An allograft or autograft hamstring is prepared
- To expose the entire MCL, an incision is made longitudinally over the medial side of the knee.
- A guide pin is carefully inserted into the medial epicondyle, avoiding accidental penetration into the intercondylar notch. Fluoroscopy may be used to aid in identifying the placement of the guide pin.
- For placing the graft, a socket is created from the guide pin to the anatomic insertion of the MCL, on the tibia, using the index finger and Metzenbaum scissors.
- The anatomic insertion sites on the tibia are identified using both anatomic and radiographich landmarks.
- The graft is secured on the femoral side first.
- The MCL graft is made taut, with the knee at 20° flexion under varus stress, and fixed to the tibia at the proximal and distal insertion sites.
- The tension in the graft is confirmed and subcutaneous tissue and skin are closed.
In the first six weeks after the surgery, weight-bearing is limited. With anatomic reconstructions that Dr. Patel performs, immediate range of motion is allowed. At 6 weeks, the brace is removed and you are allowed to bear weight.
Risks and Complications
Knee stiffness and residual instability are the most common complications associated with MCL reconstruction.