The most common knee ligament injury is an injury to the medial aspect of the knee. There are three main anatomic structures on the medial side of the knee, with the medial collateral ligament (MCL) being the largest and strongest. A large number of isolated MCL medial knee injuries are due to sporting events. They can be either a contact or non-contact stress to the outside of their knee, which in turn stretches or tears the medial knee structures on the inside of the knee.
The grade of the medial knee injury is based upon the amount of tearing present and treatment options depend on the location of the tear and if other ligaments are concurrently injured. Dr. LaPrade will operate on patients who exhibit a grade III tear or higher. In addition, it is well recognized having any “looseness” of the medial knee structures can cause an ACL graft to fail. Thus, when there is a combined medial knee injury and ACL injury, it is important to make sure the MCL injury heals completely prior to the ACL reconstruction or it should be concurrently repaired or reconstructed.
In the case of very severe combined knee ligament injuries, especially with a PCL tear, a concurrent medial knee injury should undergo a repair, augmentation repair, or a complete medial knee reconstruction (MCL reconstruction surgery).
MCL Surgical Reconstruction
Dr. LaPrade has performed extensive anatomic, biomechanical, diagnostic and other related studies to better understand medial knee injuries and structures. Through this work, he has been able to develop an anatomic medial knee reconstruction procedure which has been performed in patients and is currently undergoing clinical outcome studies.
Historically, MCL reconstruction surgery of medial knee injuries resulted in a significant amount of patients developing postoperative stiffness which often results in more surgeries. Thus, we have developed newer techniques which allow us to have patients move their knee sooner to try and decrease the risk of stiffness and the necessity of secondary surgeries. For all medial knee injuries, a careful assessment must be performed with a thorough physical examination, the use of stress x-rays and the use of high field strength MRI to identify the injury pattern.
Rehabilitation Following Injury
In the acute situation, Dr. LaPrade generally places patients into an early rehabilitation program to emphasize quadriceps reactivation, edema control and knee range of motion. For isolated acute MCL ligament injuries, most athletes can return to sports by multiplying the grade of the injury by two (in weeks) as a general time frame. Thus, a grade I acute MCL injury usually needs 1-2 weeks to heal, while a grade II injury takes 3-4 weeks to heal and a grade III isolated complete MCL ligament injury typically takes 5-6 weeks of properly guided rehabilitation to have the injury heal completely.
The use of an MCL protective knee brace is also commonly recommended in the acute situation for medial knee injuries when the knee is significantly unstable. Thus, we recommend the patient be fitted by a brace specialist who understands the patient’s goals and will properly fit the MCL brace which is durable enough for their desired activity levels.
