Distal Knee Medial Collateral Ligament Repair With Suture Augmentation

Abstract

The medial collateral ligament (MCL) is the most commonly injured ligament of the knee. Given its extra-articular location, the MCL has great healing capacity such that the mainstay of treatment for most injuries remains conservative management. However, certain injury patterns place patients and athletes at risk of residual valgus laxity, which may require delayed surgical care and prolonged time out from sports. As such, identifying the specific injuries known to place patients at risk for failure with nonoperative management is of paramount importance. Although controversy remains regarding the optimal treatment of grade III MCL injuries, it is generally accepted that MCL ruptures from the distal tibia attachment require operative fixation. This technique article with accompanying video provides a detailed description of a technique for repairing the distal MCL attachment with suture augmentation. There are several advantages associated with an augmented direct repair including early, safe rehabilitation; prevention of valgus instability; and avoiding the comorbidities associated with a larger reconstruction.

Surgical Repair of Stener-like Injuries of the Medial Collateral Ligament of the Knee in Professional Athletes

“…Although in the limited previous studies describing surgical repair of Stener-like lesions of the MCL no augmentation techniques were used, multiple studies advocate for suture tape or fiber tape augmentation of grade 3 MCL repairs to facilitate additional protection, allow early range of motion, and accelerate rehabilitation. 26,35,36 This has been corroborated with biomechanical analysis demonstrating a superior repair strength of MCL synthetic augmentation versus suture repair alone. 14 In our practice, we limit LARS augmentation for athletes with a significant injury affecting sMCL ligamentous structural integrity, severe fraying, ligament thinning, or excessive laxity.…”

“…Several studies advocate for surgical intervention of Stener-like lesions of the distal sMCL to expedite recovery and improve outcomes; nonetheless, these reports primarily describe novel surgical techniques, with limited correlation to clinical outcomes or complications. 25,30,35 To our knowledge, only 15 clinical cases and 2 radiological case series of Stener-like lesions of the sMCL have been previously reported in the literature. 7,9,20 Furthermore, although all clinically reported cases were managed surgically, postoperative outcomes have only been reported in 8 previous patients.…”

Suture Tape Augmentation Increases the Time-Zero Stiffness and Strength of Anterior Cruciate Ligament Grafts: A Cadaveric Study

“…Other authors have had success with placing a hemostat underneath the suture tape before anchor fixation. 22 Although this can be an effective measure, there are concerns that this could introduce slack to the construct and minimize the benefits of suture augmentation.…”

MCL internal brace does not fully recapitulate normal MCL function in valgus stress

“…Various means of protecting the ligament during healing, such as external bracing, have been advocated to hasten the return to athletic activity or while awaiting treatment for concomitant injuries. More recently, internal bracing with a minimally invasive surgical procedure to help protect the MCL during healing has become [3, 5, 16, 22, 26, 29, 30] available. This involves the placement of heavy suture tape over the superficial MCL, secured on the femur and tibia, to act as an internal brace for the MCL.…”