Medial-Sided Repair in Multi-Ligamentous Knee Injury

Injuries to the medial structures of the knee are common in multi-ligamentous knee injuries (MLKIs), which account for 0.02% of orthopedic injuries each year. The most common medial structure involved is the superficial medial collateral ligament (sMCL) with possible additional injury to the posterior oblique ligament (POL) and deep medial collateral ligament (dMCL). There has been little evidence for the superior management of these structures regarding the use of repair or reconstruction to reproduce overall knee function. Although reconstruction may provide more valgus stability postoperatively, the use of sMCL repair over reconstruction may be superior at reestablishing native anatomic alignment and kinematic relationships of the knee while also preserving proprioception and providing similar valgus stability.

Surgical repair of medial structures is typically indicated for third-degree injuries, bony avulsions, tibial plateau fracture, intra-articular entrapment of the end of the ligament (Stener-type lesions), or anteromedial stability. They are particularly indicated in the elite athlete who presents with excessive valgus laxity due to valgus knee loading, external rotation, or combined force vectors.

This surgical technique video demonstrates an open, medial-sided femoral and tibial approach to repair proximal and distal medial knee structures in the setting of MLKIs using case examples of a Stener lesion and a combined sMCL, POL, and medial patellofemoral ligament tears.

Repair of sMCL injuries has been reported to show favorable healing, knee stability, and function.

The use of fixation of the sMCL to its anatomical attachment points offers similar valgus stability and improved functional and patient-reported outcomes when compared with sMCL reconstruction.

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