synonyms: MCL repair, MCL reconstruction, medial collateral ligament repair
MCL Repair CPT
MCL Repair Indications
- Chronic MCL laxity / instability
- Acute MCL tear in a multi-ligament knee injury / Knee Dislocation.
MCL Repair Contraindications
MCL Repair Alternatives
- Hinged knee brace with early motion and functional rehabilitation.
MCL Repair Pre-op Planning / Special Considerations
- Have knee arthroscopy set-up available if peforming concurrent knee arthroscopy for meniscal tear.
- Reconstruction options: bone block advancement of femoral origin; Consider reinforcement with Semitendinosus autograft; achilles allograft .
MCL Repair Technique
- Pre-operative antibiotics, +/- regional block
- General endotracheal anesthesia
- Supine position. All bony prominences well padded.
- Examination under anesthesia.
- Prep and drape in standard sterile fashion.
- Consider performing Knee Arthroscopy to evaluate for concurrent meniscal tear.
- Incision: 10cm medial hockey stick longitiudinal incision centered on the medial joint line.
- Incise Sartorius fascia exposing the superficial MCL.
- The MCL is more commonly injury at is femoral origin than tibial insertion. Evaluate ligament laxity determine injury site.
- Acute injuries are repaired primarily: femoral avulsions = spiked washer and screw; midsubstance tears = #2 non-absorbable suture; tibial avulsions = spiked washer and screw.
- Chronic injuries may need bone block advancement of femoral origin.
- Consider reinforcement with Semitendinosus. The pes insertion of the Semitendinosusis left intact. The proximal end is harvested with an open ended tendon stripper and then looped over the screw and washer and sutured back into itself. Must determine isometric point on medial epicondyle. Other options: achilles allograft with calcenal bone block fixed to medial epicondyle and tendon to anterolateral tibia 2-4cm distal to the medial joint line.
- Close sartorial fascia
- Close in layers.
MCL Repair Complications
- Painful hardware:
- Arthrofibrosis: rare
- NVI (saphenous neuralgia): rare
- Complex Regional Pain Syndrome: rare
MCL Repair Follow-up care
- Hinged knee brace with early motion and functional rehabilitation. Typically allow 15° to 60° ROM for first 4-6weeks. 20% weight bearing with crutches
- 6 weeks post-op: open brace from 0°-120°. WBAT
- 10 weeks post-op: discontinue brace, advance activities.
- Return to sport / full activites at 6-12 months.
- For combined ligament injuries generally follow cruciate ligamet post-op protocol.
MCL Repair Outcomes
MCL Repair Review References