Medial collateral ligament and posteromedial corner repair and reconstruction

When the conservative management of medial collateral ligament (MCL) tears fails or, in severe cases, if valgus gapping is present in full extension, an anatomic medial knee reconstruction technique is preferred. This technique provides quality restoration of knee static function, improves overall knee stability, allows for immediate postoperative knee motion during subsequent physical rehabilitation, and reduces the risk of postoperative stiffness complications that are common in other medial knee surgeries. The procedure comprises both a superficial medial collateral and posterior oblique ligament reconstruction and is comprised of two individual grafts and four reconstruction tunnels. Anatomic medial knee reconstruction has shown significant improvements in IKDC scores and restoration of medial knee stability with a low risk of arthrofibrosis.

Medial knee reconstruction is recommended when conservative management of MCL tears fails or if valgus gapping is present in full extension.

Anatomic medial knee reconstruction technique is favored because it restores knee static function, enhances knee stability, allows for immediate postoperative knee motion, and reduces the risk of postoperative stiffness complications.

Increased gapping appreciated at 20 degrees of flexion suggests isolated superficial MCL injury, while increased gapping at full extension indicates severe MCL or posteromedial corner (PMC) injury with possible cruciate ligament involvement.

The anterior cruciate ligament provides additional restraint to valgus stress testing if the medial knee structures are completely torn.

Increased tibial internal or external rotation indicates injury to the distal aspect of the superficial medial collateral ligament, the meniscotibial division of the deep medial collateral ligament, and the posterior oblique ligament.

Anatomic reconstruction has shown increases in subjective IKDC scores and improvement of side-to-side medial instability.