Proximal advancement of the medial collateral ligament for chronic medial instability of the knee joint

Abstract

A retrospective study was designed to judge the efficacy of proximal advancement of the medial collateral ligament (MCL) for chronic medial instability of the knee joint. Over a twelve month period, seven patients presented to us with chronic medial knee instability. Four of these had a complete tear of the MCL as an isolated injury and three had an associated cruciate injury, anterior cruciate ligament (ACL) in two patients and posterior cruciate ligament (PCL) in one patient. Patients with a cruciate injury underwent arthroscopic reconstruction using patellar tendon graft and had six months of intensive physiotherapy. The follow up consisted of a questionnaire and physical examination. They were graded on the IKDC and Lysholm knee scoring scales. The average duration of follow up was 31 months. We report good to excellent results on all our patients on the Lysholm scale and in spite of three patients having their knees recorded as abnormal on the IKDC scale, all of them were satisfied, had no pain or residual instability and were back to sporting activities without any external support. While reviewing the literature, we did not come across proximal advancement of the MCL in isolation as performed by us as treatment for chronic medial knee instability though it has been performed previously with a different operative technique or in association with more extensive surgical intervention. Thus, in those few patients who require surgical intervention for this problem, we advocate this technique as a simple and reliable method for treating chronic medial knee instability.