Medial-Sided Repair in Multi-Ligamentous Knee Injury

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Knee Biomechanics

Background:

• Multi-ligamentous knee injuries (MLKIs) are relatively uncommon orthopedic injuries.
• Medial knee structures, particularly the superficial medial collateral ligament (sMCL), are frequently involved in MLKIs.
• Optimal management strategies for medial knee structure injuries (repair vs. reconstruction) remain debated.

Purpose of the Study:

• To evaluate the efficacy of surgical repair versus reconstruction for injuries to the medial knee structures in MLKIs.
• To compare the functional and biomechanical outcomes of sMCL repair and reconstruction.
• To highlight a surgical technique for open medial-sided repair of proximal and distal knee structures.

Main Methods:

• Demonstration of an open, medial-sided surgical approach for repairing proximal and distal medial knee structures.
• Utilized case examples including Stener lesions and combined sMCL, POL, and MPFL tears.
• Review of existing literature comparing sMCL repair and reconstruction outcomes.

Main Results:

• sMCL repair has shown favorable healing, knee stability, and functional outcomes in reported cases.
• Fixation of the sMCL to anatomical attachment points provides comparable valgus stability to reconstruction.
• sMCL repair demonstrated improved functional and patient-reported outcomes compared to reconstruction.

Conclusions:

• Surgical repair of the sMCL may be a superior treatment option compared to reconstruction for MLKIs.
• Repairing the sMCL to its native attachment points can better reestablish knee alignment and kinematics.
• sMCL repair preserves proprioception and offers comparable valgus stability with improved functional outcomes.