8 - Repair and Reconstruction of the Superficial Medial Collateral Ligament and the Posteromedial Corner

Abstract

This chapter describes the clinical background for medial knee instability and the indications for surgical treatment of medial collateral ligament (MCL) and posteromedial corner injuries. Historically, treatment of acute medial collateral ligament injuries has focused on nonoperative therapies with early controlled motion with relatively good reported patient outcomes. However, more severe acute and symptomatic chronic medial knee injuries may require operative management. Injuries that involve all medial and posteromedial structures, the superficial MCL, the deep MCL, the posterior oblique ligament and the posterior capsule are characterised as a grade 3 injury and have a greater risk of developing chronic medial and rotatory instability requiring surgical treatment. In this chapter the anatomical and biomechanical background for medial knee laxity is presented and related to clinical evaluation. Treatment decision strategies are detailed based on clinical and imaging findings. Finally the key techniques for anatomical reconstruction of the MCL are described, including their clinical outcomes.