Breaking Down the Posteromedial Corner: Medial Collateral Ligament Augmentation

The medial collateral ligament (MCL) is often injured after a valgus stress is applied to the knee, which stresses the medial compartment. Pivoting and rotational movements during sports frequently cause MCL injuries.

Selection of a surgical treatment option depends on the chronicity of the MCL injury, lower-limb axis alignment, the grade of the MCL injury, and other patient-specific factors.

A medial hockey stick incision extending from proximal to the medial epicondyle to 7 cm distal to the joint line was made. The gracilis and semitendinosus tendons were identified after dissecting through the sartorial fascia. These tendons were then harvested using an open tendon stripper, leaving their distal tibial insertions undisturbed. A measurement of 6.1 cm distal to the joint line on the tibia was marked, establishing the distal attachment site of the superficial MCL. To better orient the harvested tendons, an anchor was placed in this location. The adductor magnus tendon and adductor tubercle were then identified, and measurements were made 12 mm distal and 8 mm anterior to the adductor tubercle, corresponding to the femoral attachment of the superficial MCL. A guide pin was placed at this location, and the knee was taken through a full range of motion to ensure isometry. A mark was placed 12 mm distal to the joint line, and a second anchor was placed here to recreate the tibial insertion site of the deep MCL. The graft was then passed distal to proximal underneath the plane lying directly over the MCL. The graft was then docked into the femoral socket and secured with a tenodesis screw with the knee in 30° of flexion and slight varus force.

Patients can expect improved clinical outcomes after posteromedial (PMC) reconstruction of the knee compared with a PMC repair. There is a significant decrease in the risk of failure when surgeons perform a PMC reconstruction.

Patients who undergo isolated MCL reconstruction can expect to remain nonweightbearing for the first 6 weeks after surgery. At 12 weeks postoperatively, patients should achieve a full, painless range of motion. Return to sport is typically between 6 and 9 months after MCL reconstruction.

The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.