Medial collateral ligament rupture

Pre-Operation

Contact injury causing a MCL injury

The left knee MCL is being examined to determine the severity of the injury.

The MCL injury may occur as a result of a contact injury, typically one of the codes of football, or a non-contact injury, such as twisting or pivoting.

Usually there is immediate pain at the medial (inside) of the knee and the knee may feel unstable with the more severe injuries.

The diagnosis is often possible with a clinical assessment. However in the case of more severe injuries, an MRI may be of use in treatment planning, and operative planning in particular. An ultrasound is of little value in the management of these patients.

MCL ruptures, even the more severe ones can often be managed without surgery. This requires the knee to be placed in a range of motion brace (ROM) brace locked at 20 degrees of flexion. The brace must be worn 24/7 for 6 weeks, in order for it to succeed. The patient does need to be prepared for this. A blood thinner should be taken during this period to reduce the risk of a leg thrombosis forming.

Sometimes the presence of other injuries, such as multi-ligament knee injury, or a fracture, may need urgent surgical attention, in which case it may be better to operate on the MCL at the same time.

The decision on whether or not to operate may also be influenced by the patient’s activity level. Professional athletes and / or performing athletes may benefit from surgical intervention with a quicker recovery, albeit with an increased risk of complications.

Operation

Repair of the MCL using suture anchors

Reconstruction of the MCL using a graft

The operation is performed with the patient under a general anaesthetic, in an operation theatre.

The operation requires an incision over part or all of the MCL. The damage component of the ligament is explored and repaired, using sutures and / or suture anchors.

In some patients this will be augmented by an artificial ligament placed superficial to the repaired native ligament, and apposed to it. This ligament acts as an internal brace and supports the native ligament while it heals, and at the same time permits early rehabilitation.

The knee is placed in a range of motion (ROM) brace, locked in full extension. The patient is allowed to put weight through the knee with the brace on. The range of motion permitted is gradually increased over the next 8 weeks, at a rate determined by the solidity of the repair.

Some patients will go home on the day of surgery, while most will stay in if the MCL is repaired as part of a more complex operation.

Potential
complications

Despite our best attempts, potential complications are a risk with any injury or surgical procedure. You need to be aware of these rare potential complications.

The more common ones are listed here, but please ask the surgeon if there are any you are particularly concerned about.

1. Infection

The risk of this is less than 1% and is reduced with intra-venous antibiotics during the procedure and tablets for 5 days thereafter.

2. Nerve or vessel injury

The risk of this is very low. There may be some bruising, but this will heal, and there may be some numbness related to the laceration through the skin to the level of the MCL.

3. Thromboembolism

There is a risk of forming a venous thrombosis, blood clot, in the calf. This risk is present even without surgery. The risk is increased if the patient uses nicotine and / or there is a personal or family of history of thromboembolic disease. The risk is also increased as a result of underlying medical conditions, and this will be discussed prior to surgery if relevant.

4. Recurrence

Recurrent MCL rupture is rare following surgical repair and / or reconstruction, less than 1% per year.

5. Stiffness

Some patients will experience stiffness following the operation and may be slow to regain a full range of flexion. This results from both the injury and the surgery to correct the MCL laxity. The best way to prevent this is adherence to the prescribed rehabilitation protocol, designed to increase the range of motion safely. In some cases a mobilization under anaesthesia is required.

6. Implant irritation

The implants used may cause significant irritation, especially if staples are used. In most cases this settles down, but if not the implants causing irritation can be removed as soon as the ligament has healed sufficiently. Following this the patient can return to their rehabilitation as soon as possible.

Post-Operation

Most patients will take close to 2 weeks of work, if they have a clerical type job. Manual work may take 6-12 weeks to return to, depending upon the availability of light duties.

Dr. Porter will review the patient in the rooms at the post-operative review to check the wounds. He will communicate with your physiotherapist who will supervise the rehabilitation program. There will be regular reviews thereafter and Dr. Porter will see you at any stage if there are any problems with the rehabilitation.

Most patients will go home with oral antibiotics for 5 days, analgesia and a blood thinner to reduce the risk of forming a DVT.

Rehab / Physio

The specific rehabilitation protocol may vary, depending upon the nature of the MCL injury, the presence of other injuries, and the surgery performed.

The PDF version of the standard protocol for an MCL repair with augmentation is available by clicking on the link below.

https://www.cosm.net.au/wp-content/uploads/2019/04/MCL-reconstruction.pdf