MCL Surgery – The medial collateral ligament (MCL) is one of four major ligaments of the knee that connects the femur (thighbone) to the tibia (shinbone) 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.
How is an MCL injury diagnosed?
An MCL injury can be diagnosed with a thorough physical examination of the knee and diagnostic tests such as X-rays, MRI scans and arthroscopy. X-rays may help rule out any fractures. In addition, your doctor will perform a valgus stress test to check for stability of the MCL. In this test, the knee is bent approximately 30° and pressure is applied on its outside surface. Excessive pain or laxity is indicative of medial collateral ligament injury.
How is an MCL injury treated?
If the overall stability of the knee is intact, your doctor will recommend non-surgical methods including R.I.C.E., physical therapy and bracing. Surgical reconstruction is rarely recommended for MCL tears, but may be necessary in patients who are failing to heal properly with residual knee instability.
These cases are often associated with other ligament injuries, such as a torn ACL as the result of trauma. If surgery is required, a ligament repair may be performed, with or without reconstruction with a tendon graft, depending on the location and severity of the injury.
MCL surgery
If all other non-surgical treatment options have been exhausted, your orthopedist will recommend MCL surgery.
The procedure is performed under general anesthesia. Arthroscopic examination of the knee may be performed to rule out any associated injuries including anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) tears.
The surgical procedure for medial collateral ligament reconstruction involves the following steps:
- Your surgeon will make an incision over the medial femoral condyle.
- Care is taken to move muscles, tendons and nerves out of the way.
- The donor tendon is usually harvested from the Achilles tendon.
- The soft tissue around the femur is debrided to assist the insertion of the Achilles bone plug.
- For placing the graft, a tunnel is created from a guide pin to the anatomic insertion of the MCL on the tibia, using the index finger and surgical scissors.
- The Achilles tendon allograft is inserted in the femoral tunnel and fixed using screws.
- The MCL graft is made taut, with the knee at 20° flexion under varus stress, and fixed to the tibia.
- The incision is closed with sutures and covered with sterile dressings.
MCL surgery recovery
You will wear a knee brace for around 6 weeks following your MCL surgery. Your surgical team will coordinate with your physical therapy team to come up with a plan to get you back to normal as soon as possible. It is very important that you stick with this therapy plan to regain full mobility of your MCL and knee.
If you complete your physical therapy regimen, you should regain normal mobility within 6 to 8 weeks. Crutches may be required for around 6 weeks, or until your are given the all-clear by your doctor.