AANA Middle East Arthroscopy Master Course (International)-MCL

MCL_PMC Injuries

Pdf Summary

This presentation by Dr. Robert Hunter at the AANA Middle East Arthroscopy Master Course in 2019 focused on medial collateral ligament (MCL) and posteromedial corner (PMC) injuries, exploring when and how to repair these structures, particularly in the context of meniscus pathology and knee stability.<br /><br />Key points include the functional anatomy of the medial knee, with the MCL providing primary valgus and rotational stability and the posteromedial ligament (POL) also contributing, especially in extension. Injuries are assessed via physical exam (notably grade 3 valgus laxity and anteromedial rotatory instability) and MRI to determine tear location and associated pathology.<br /><br />The healing prognosis depends on tear location—proximal MCL tears generally heal well, mid-substance may heal, distal tears often do not, especially displaced distal tears termed “Stener lesions of the knee,” which require acute repair. Isolated acute MCL injuries often heal non-operatively, but combined ligament injuries (ACL/MCL, PCL/MCL) complicate healing, necessitating ACL or PCL stabilization for MCL healing.<br /><br />A prospective randomized study cited showed superior outcomes for ACL reconstruction combined with non-operative MCL treatment versus MCL repair, with better flexion and quadriceps strength in the non-op group. Surgical repair or reconstruction indications are refined: isolated MCL injuries are rarely repaired surgically, except for displaced distal tears or rare bony avulsions requiring acute repair. Chronic isolated grade 3 laxity may warrant reconstruction, but combined ACL/MCL injuries generally require surgical intervention.<br /><br />Dr. Hunter emphasized careful preoperative evaluation, including examination under anesthesia and intraoperative fluoroscopy to ensure anatomic reconstruction and full extension restoration.<br /><br />In summary, surgical management of MCL/PMC injuries is selective, driven by injury severity, location, knee stability, and associated ligament injuries, favoring non-operative care for many isolated MCL injuries but reconstructing when combined injuries or displaced tears compromise knee stability.

Keywords

medial collateral ligament

posteromedial corner

MCL injuries

knee stability

meniscus pathology

valgus laxity

anteromedial rotatory instability

Stener lesions

ACL reconstruction

surgical repair indications