Richard Cunningham, MD is a board certified orthopedic surgeon and sports medicine specialist with over 20 years of experience. He is widely known for expert treatment of knee and shoulder problems. Knee injuries often involve ligament tears of the knee. Tears of the medial collateral ligament (MCL) are common, especially in our active population. Mild to moderate tears of the MCL can be treated non-surgically, but severe tears may need surgery. Patients often ask, “Will my MCL injury heal on its own or will I need an MCL repair?” Dr. Cunningham wants patients to know what to expect with MCL injury and the treatment options.

MCL Injury

Patients with an MCL injury have damage to the main stabilizing ligament at the inner (medial) aspect of the knee joint. The MCL originates off the femur (thigh bone) and attaches to the tibia (shin bone). It acts to stabilize the knee by preventing the knee from going into a knock kneed position. A tear of the MCL is usually caused by a blow to the outer (lateral) side of the knee. This injury is rated on 1-3 scale. This includes:

• Grade 1 – partial tear with mild laxity
• Grade 2 – partial tear with moderate laxity
• Grade 3 – complete tear with severe laxity

Most MCL tears are either grade 1 or grade 2, and these usually heal well by being protected in a hinged knee brace. Healing is usually complete in 4-6 weeks for grade 1 tears and 8 weeks for grade 2 tears.

Grade 3 MCL tears are often associated with other associated tears such as ACL tears. Isolated grade 3 MCL tears may heal in a brace, but most only heal to a grade 1 where mild laxity persists. Grade 3 tears that are not diagnosed early on and braced do not heal and these may require surgical reconstruction in order to make the knee stable once again. Also, some grade 3 tears tear in such a way that the fibers are seen to be retracted on an MRI and these types do not heal well without surgery.

Indications for MCL Repair and MCL Reconstruction

MCL reconstruction using a piece of donor tendon to reinforce the stretched out MCL 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, 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.

Some MCL tears can be treated with simply repairing it and not utilizing a donor tendon to reconstruct it. In this case, the entire ligament is seen to be intact on MRI, but the ligament has pulled away from its attachment site. In repairs, the torn ligament fibers are reattached to the bone with suture anchors. For MCL tears where the entire ligament was damaged and brace treatment was not successful, then MCL reconstruction may be required.

MCL Repair vs. MCL Reconstruction

Dr. Cunningham works closely with each patient to determine the optimal treatment for the individual’s MCL injury. Whether MCL repair or MCL reconstruction, the patient can expect a return of full range of motion, strength, and stability.

MCL Repair – When MCL repair is recommended, the procedure results in a re-anchoring of the ligament to the bone using suture anchors which are small, nonmetallic devices that anchor into the bone and have strong stitch material attached to them. The surgery is done through one or two incisions along the inner aspect of the knee. It is usually completed at a surgery center with no hospital stay required. The recovery and rehabilitation process results in a return of overall knee function.

MCL Reconstruction – For patients receiving an MCL reconstruction, the surgery is similar to a repair, but the damaged MCL is reinforced with an allograft (donor tendon) that is sewn into the MCL and anchored to the bone attachment points. This results in the preservation of the native ligament but augmenting, reinforcing and tightening it.

Dr. Cunningham’s experience in treating MCL injuries makes him a top choice for patients. He and his expert care team are trusted by patients for optimal results. Request a consultation with Dr. Cunningham today. In Vail, CO at: (970) 476-2451, in Frisco at: (970) 668-3633, and Edwards at: (970) 569-3240.