A Review of Surgical and Nonsurgical Outcomes of Medial Knee Injuries

Abstract

Medial-sided knee injuries can result in pain, instability, and loss of function. Many clinical studies have been written on the treatment of medial-sided knee injuries; however, the vast majority are isolated case series of surgical or nonoperative treatment regimens, and only a few randomized prospective clinical trials can be found in the literature that compare different treatment modalities. Comparison of these treatments is challenging due to the variety of medial-sided structures that can be involved, the multiple different approaches to treatment, and the variability of how objective and subjective clinical outcomes are reported. In this paper we report on the injuries by extent and type of anatomic structures damaged including partial medial-sided injuries, completed isolated medial-sided knee injuries, and combined injuries. In general, most authors concur that isolated partial or complete medial collateral ligament (MCL) injuries can be treated nonoperatively with a brace and early motion with good clinical outcomes. Prospective, randomized trials support nonoperative treatment of the MCL in combined anterior cruciate ligament-MCL injuries. Knee dislocations and posterior medial corner injuries appear to have better results with surgical management including reconstruction. Multiple reconstructive techniques have been described for chronic injuries but it is difficult to compare their results.

Core curriculum case illustration: [Stieda fracture (avulsion fracture of the medial femoral condyle)]

“…Reconstruction of the medial ligamentous structures of the knee is usually performed if there is persistent valgus laxity or anteromedial rotatory instability after nonoperative management [5]. When combined with an anterior cruciate ligament (ACL) tear, an ACL reconstruction is performed in a delayed manner after healing of the MCL and return of knee full range of movement.…”

Practice Guidelines for the Management of Multiligamentous Injuries of the Knee

“…Whereas MCL complex has shown good results with both surgical and nonoperative management following definitive surgery where Grade II and III injuries typically from its femoral attachment have better prognosis as compared to injury at the tibial attachment. 42 57 58 59 …”

Medial collateral ligament reconstruction using bone-patellar tendon-bone allograft for chronic medial knee instability combined with multi-ligament injuries: a new technique

“…It was generally accepted that isolated low-grade, partial medial collateral ligament injuries (grade I and II) could be treated nonoperatively [ 18 ]. While the surgery was recommended in cases of complete medial knee injuries (grade III) or with concomitant cruciate ligament injuries [ 18 ], some surgeons have recommended MCL reconstruction rather than surgical repair for chronic phase because poor-quality scarring and incomplete healing of the MCL are very difficult to identify and repair of those structures could hardly yield satisfactory results [ 7 , 8 , 19 ]. In addition, in cases of complete medial knee injuries combined with cruciate ligament injuries, MCL reconstruction was more reliable than simple repair to restore knee stability [ 8 ].…”