AANA Lab Course 913 - Advanced Knee Course-MCL Injuries_ Decision Making and Operative Techniques Faculty Lecture

MCL Injuries_ Decision Making and Operative Techniques Faculty Lecture_ Alexander K. Meininger, MD

Pdf Summary

This presentation by Dr. Alexander K. Meininger focuses on decision-making and operative techniques for medial collateral ligament (MCL) injuries. The MCL anatomy and diagnosis, including MRI and arthroscopy findings, are reviewed, with emphasis on injury grading, location, and whether injuries are isolated or combined.<br /><br />Treatment options for MCL injuries include conservative management, biologics/regenerative medicine, repair, augmentation, and reconstruction. Nonoperative treatment is generally preferred for partial tears (Grade I and II), with a noted average of 10.6 and 19.5 lost playing days respectively. However, Grade III tears often result in persistent instability (70-94%), especially when combined with ACL injuries, which may require staged ACL reconstruction with functional bracing or combined repair/reconstruction.<br /><br />Use of platelet-rich plasma (PRP) immediately after injury has not shown clear benefits in ligament healing based on basic science and limited clinical evidence. While some chronic cases saw success with autologous leukocyte-poor PRP, overall tissue healing benefits remain uncertain.<br /><br />Suture bridge techniques using internal brace ligament augmentation have gained traction, with studies demonstrating successful repair and augmentation in multiligament injured knees, improving medial stability and patient satisfaction.<br /><br />Primary repair and repair with augmentation have shown promising clinical results, including high patient satisfaction and good medial stability on follow-up. Reconstruction, often with Achilles tendon grafts, is reserved for chronic or severe (Grade III) injuries including three-ligament injuries, with short to midterm outcomes showing 86% of patients returning to pre-injury activity by approximately four years.<br /><br />In summary, isolated and combined Grade I/II MCL injuries are usually treated conservatively. Acute avulsion repairs are ideally performed within three weeks, addressing both deep and superficial MCL components. Augmentation is recommended in cases with poor tissue quality or rotatory instability, while reconstruction is indicated for complex multiligament injuries.

Keywords

Medial Collateral Ligament

MCL Injuries

Decision-Making

Operative Techniques

MRI Diagnosis

Arthroscopy

Conservative Treatment

Platelet-Rich Plasma

Suture Bridge Technique

Ligament Reconstruction