MEDIAL COLLATERAL LIGAMENT (MCL) RECONSTRUCTION
The medial collateral ligament (MCL) is one of the four major ligaments in the knee. The MCL is on the inside of the knee and runs from the end of the femur (thigh bone) to the top of the tibia (shin bone). The primary role of the MCL is to provide knee stability in the frontal plane. The MCL is particularly important in providing stability to the knee when stress is placed on the outside of the knee, which places the MCL under tension. Too much stress can lead to an MCL sprain (tear). MCL injuries, like ACL injuries, are graded I-III (III most severe).
Most patients with Grade III MCL strains (complete tear) are treated non-operatively with a brace and physical therapy. Unlike the ACL, a completely torn MCL can heal on its own with appropriate tension. However, in some cases, the MCL does not heal and surgery may be required. This is common when patients tear both the ACL and the MCL. The goal of MCL surgery is to stabilize the knee. There are two ways to restore stability: either with a direct repair of the torn tissue or by replacing the torn MCL with healthier donor tissue (reconstruction). If a reconstruction is performed, Dr. Welch can use either healthy tissue from a cadaver (allograft tissue) or from the patient’s own body (autograft). The new tissue must be placed in the right position in the knee and must be tensioned appropriately to restore stability to the knee.
Multiple grafts (replacement tissue) are available to reconstruct the MCL or provide additional support to a direct repair of the torn MCL. Allografts include achilles tendon and hamstring, among others. Generally speaking, Dr. Welch prefers using allograft for MCL reconstruction.
Following surgery, patients are placed in a brace that is locked straight. When the patient is sitting or lying down, Dr. Welch encourages knee range of motion exercises with the brace removed. Dr. Welch also recommends intermittent icing and straight leg raise exercises to strengthen the quadriceps muscles. Dr. Welch recommends starting physical therapy one weeks after surgery. Physical therapy focuses on reducing swelling in the knee, restoring full range of motion, and eventually, restoring strength to the knee with particular emphasis placed on the quadriceps. Dr. Welch recommends advancing the physical therapy program to cutting, pivoting, and sport-specific activities only after the patient has achieved certain goals (for example, appropriate quadriceps strength, appropriate range of motion, etc.). Most patients start sport-specific training approximately 4-6 months after surgery. Most patients return to competitive sports approximately six months after surgery. It is very important to follow the rehabilitation process carefully to achieve the best outcome.