MCL/LCL/PLC/ALL RECONSTRUCTION

Arthroscopy

MCL (MEDIAL COLLATERAL LIGAMENT)

The medial collateral ligament (MCL) serves as the primary stabilizing ligament on the inner side of the knee. Its primary role is to safeguard against inward buckling or knock-knee motion (valgus motion). Injuries or tears to this ligament can lead to instability in the knee.

Causes

MCL tears usually result from trauma, such as a direct force applied to the outside of the knee, which strains the ligament. This type of injury commonly happens in collision sports like football. Additionally, overuse injuries in activities or professions involving repetitive kneeling and rapid standing up can also cause micro-tears in the ligament.

Symptoms

MCL tears typically result in sudden pain and frequently lead to swelling. You might sense a distinct "pop" sensation on the inner side of the knee. The pain tends to be focused around the ligament, specifically on the inner aspect of the knee. It's possible to walk after the injury, but depending on how severe the tear is, the knee may feel unstable or as if it might give out. The MCL connects to the underlying meniscus, and injury to the meniscus during the incident could result in clicking or locking of the knee.

Diagnosis

Your surgeon will conduct a comprehensive assessment, including a detailed history and physical examination along with X-rays. During the examination, they will observe swelling, as well as detect limitations in motion and strength. The surgeon will also perform specific maneuvers to assess the stability of the knee ligaments and meniscus. An MRI scan can provide valuable confirmation of the diagnosis, particularly revealing any tears in the ACL. Furthermore, the MRI may distinguish the type of tear—whether partial, complete, or avulsion from either the tibia or femur—providing essential information for surgical planning. Additionally, the MRI might reveal bruising of the bone resulting from the injury.

Non-operative

The majority of minor MCL tears can be managed without surgery. Non-surgical approaches typically involve using a brace, taking anti-inflammatory medication, undergoing physical therapy, applying cryotherapy, and making adjustments to activities to reduce swelling, restore movement, and regain strength. For many patients, surgery is unnecessary, as they can resume normal exercise routines with proper care, depending on the extent and nature of the tear. In cases where symptoms persist, such as persistent pain or instability, your surgeon may advise reconstruction surgery.

Operative

The management of MCL tears varies depending on the specific type of tear. In cases where the MCL is torn off from either the femur (thigh bone) or tibia (shin bone), surgical repair may be recommended. This involves making small incisions and reattaching the MCL back into place using screws or buttons, often reinforced with strong sutures. Alternatively, if a more extensive reconstruction is needed, a new MCL graft can be utilized to replace the damaged ligament. The choice of technique and graft material is a collaborative decision between the patient and their surgeon. Typically, these procedures are minimally invasive and can involve taking the graft from either around the knee or from a donor source. The timeline for postoperative rehabilitation, return to daily activities, and resumption of sports participation varies based on the specific surgical approach and graft used, as determined by the surgeon.

LCL (LATERAL COLLATERAL LIGAMENT)

The lateral collateral ligament (LCL) serves as the primary stabilizing ligament located on the outer side of the knee. Its key role is to safeguard against the knee buckling outward (varus motion). Damage or tears to this ligament can lead to instability in the knee.

Causes

LCL tears are not a common occurrence, usually resulting from trauma. The ligament is usually stressed by a direct force to the inside of the knee, a scenario often encountered in collision sports such as football. Additionally, high-energy trauma like motor vehicle accidents can lead to LCL tears. These tears often coincide with injuries to other ligaments and tendons around the knee, collectively known as posterolateral corner injury and knee dislocation.

Diagnosis

Your surgeon will conduct a comprehensive evaluation, including a detailed history and physical examination along with X-rays. During the examination, signs such as swelling and reduced motion and strength will be observed. The surgeon will also perform specific maneuvers to assess the stability of the knee ligaments and the meniscus. An MRI scan can be beneficial in confirming the diagnosis, particularly revealing any tears in the LCL (lateral collateral ligament). This imaging can specify the type of tear (partial, complete, or avulsion from either the tibia or femur), aiding in the planning of treatment. Additionally, the MRI might reveal bone bruising as a result of the injury.

Non-operative

The majority of minor LCL tears can be managed without surgery. Non-surgical approaches, such as using braces, taking anti-inflammatory medication, undergoing physical therapy, applying cryotherapy, and modifying activities, are typically recommended to reduce swelling, restore mobility, and strengthen the affected area. Depending on the tear's type and severity, most individuals can resume normal activities without needing surgery. However, a brace might be advised for returning to sports. If symptoms persist, like pain or instability, your surgeon may suggest reconstruction surgery. Additionally, if other knee structures, such as the Posterolateral Corner, are damaged, surgical intervention is often necessary to reconstruct the knee.

Operative

Treatment of LCL tears varies depending on the tear type. When the LCL is detached from the femur or tibia, repair may be necessary. This involves making small incisions to reattach the ligament, often securing it with screws or buttons, and reinforcing it with strong sutures if needed. In cases requiring formal reconstruction, a new LCL graft is typically utilized. The choice of graft and placement technique is a collaborative decision between the patient and surgeon. Most procedures are minimally invasive, with grafts sourced either locally or from a donor. The timeline for rehabilitation, resuming daily activities, and returning to sports is determined by the chosen technique and graft, under the discretion of the surgeon.

PLC (POSTEROLATERAL CORNER)

The management approach for LCL tears varies depending on the specific type of tear. Repairing the LCL may be necessary if it’s torn away from either the femur (thigh bone) or tibia (shin bone). This repair procedure involves making small incisions through which the torn ligament is sewn back into its original position and secured using screws or buttons. Additionally, high-strength sutures may be used to reinforce the repair. In cases where formal reconstruction is deemed necessary, a new LCL graft replaces the original ligament. The choice of graft and technique for its placement is a decision made collaboratively between you and your surgeon. Typically, these procedures are minimally invasive, and the graft can either be harvested from around your knee or obtained from a donor source. The timeline for postoperative rehabilitation, return to daily activities, and resumption of sports participation varies depending on the chosen technique and graft, guided by the discretion of your surgeon.

Although rare, injuries to the posterolateral corner (PLC) can lead to persistent instability and failure of cruciate ligament reconstruction if left undiagnosed. Understanding the anatomy of the PLC was once considered challenging due to inconsistent terminology in the literature, adding unnecessary complexity. However, recent biomechanical studies have identified three primary stabilizing structures in the PLC: the lateral collateral ligament, popliteus tendon, and popliteofibular ligament. Other structures within the posterolateral ligamentous complex include the short and long head tendons of the biceps femoris muscle, arcuate ligament, meniscopopliteal fascicles, and fabellofibular ligament. These structures primarily resist varus angulation, sometimes referred to as various rotation and external tibial rotation, serving as secondary stabilizers alongside cruciate ligaments to prevent anterior and posterior translation, particularly during the early phase of flexion (0-30 degrees).