What is MCL Reconstruction?
Medial collateral ligament (MCL) reconstruction is used to correct residual looseness or laxity in one’s MCL following an MCL tear that did not heal well. In MCL reconstruction surgery, a patient’s stretched out MCL is not removed but rather reinforced and tightened by augmenting it with another tendon, usually a donor tendon. Dr. Cunningham is a knee surgeon at Vail Summit Orthopedics and Neurosurgery. He is an expert at diagnosing and treating MCL injuries for patients in Vail, Summit County, Aspen, and Denver, CO.
When is MCL Tear Surgery Needed?
Following an MCL tear, you should rest, ice, compress, and elevate the knee. An orthopedic evaluation by a knee specialist is recommended. The orthopedist will evaluate the knee to confirm whether there are other injuries besides an MCL tear and also what grade the MCL tear is. Xrays will be obtained. Depending on the physical exam findings, an MRI may also be ordered.
Most MCL tears will heal in a knee brace as long as the injured MCL is immediately protected in the brace soon after the injury, patients are compliant in wearing the brace, and patients avoid any activities that can further stretch the injured MCL while it is trying to heal. However not all MCL tears will heal normally in a brace and some MCL tears require surgical reconstruction to fix them and restore full stability to the knee. MCL surgery is needed when:
- Patients continue to feel unstable and the MCL is found to be lax on physical exam despite 6 weeks of wearing a knee brace.
- MCL tears where the ligament is seen on an MRI to have pulled away from its normal attachment site on the tibia (not the femur) and is significantly retracted such that it will not heal in its proper position.
- Chronic MCL laxity following a knee injury in the distant past that never fully healed and where patients have continued instability and pain.
- A major knee injury resulting in multiple ligaments tears in the knee including the MCL
How is MCL Surgery Performed?
The goal of MCL reconstruction is to restore knee stability and return full range of motion and strength to the knee. An MCL surgery is not arthroscopic, as the injured MCL lies outside the knee joint and arthroscopic surgery is largely reserved for the treatment of problems inside of joints. A small incision is made over the MCL’s normal attachment site on the femur and another small incision is made over the MCL’s normal attachment site on the tibia. Small bone sockets are made in these attachment sites. A donor tendon is prepared and then anchored into the bone socket in the femur and into the bone socket in the tibia. The graft is also sewn into one’s stretched out MCL, thus preserving one’s injured MCL, but reinforcing it and tightening it.
What is the Recovery After MCL Surgery?
- Patients are placed in a large, hinged knee brace for 6 weeks.
- Rest, ice, compress, and elevate the knee initially
- Pain medications are prescribed but use these sparingly
- Patients are placed on crutches, with no weight bearing allowed on the leg for 4 weeks. After the first 4 weeks, partial weight bearing is started such that one is full weight bearing at 6 weeks from surgery.
- Physical therapy is started immediately after surgery.
The goal of the first 6 weeks after MCL surgery is to restore full range of motion to the knee. The goal of weeks 6-12 is to regain full strength in the knee. It can take 3-4 months for the MCL to be fully healed, to have full strength, and to be allowed to return to all cutting and pivoting sports. If there are other ligaments that require repair, the recovery is longer. Dr. Cunningham is a knee surgeon at Vail Summit Orthopedics and Neurosurgery. He is an expert at diagnosing and treating MCL injuries for patients in Vail, Summit County, Aspen, and Denver, CO.