Early Diagnosis and Primary Repair of a Rare Injury of Superficial Medial Collateral Ligament of Knee: Stener-Type Lesion

Abstract

Introduction: Medial Collateral ligament (MCL) is the primary stabilizer of knee joint against valgus stress force. Sprains of MCL are fairly common due to any injury and are treated conservatively most of the time. These have been classified by Hughston in grades I, II and III based on the severity. While grades I and II mostly have only sprain of the ligament, grade III is complete tears and may warrant surgical correction. Stener-type lesion is a rare finding seen with grade III MCL injuries. Here, superficial MCL (sMCL) tears at its distal insertion and is retracted upwards leading to pes anserinus tendon to lie in between the bed and its distal end. This does not allow the MCL tendon to regain its attachment to bed and needs surgical correction. Material/Methods: We report five patients who presented to us with stener-like lesion. They were then operated with repair of MCL tendon and its reattachment to the Tibial bed using similar techniques. Pre-procedure outcome values (Lysholm score and KOOS score) were evaluated and the patients were followed up for 1 year. At the final follow up, final outcome values were calculated along with complete clinical examination was done. Results: All five patients were fully satisfied and reported no problems in resuming work and daily activities. Clinical evaluation was done and there was reported no joint laxity or opening of joint line with varus/valgus stress conditions. There was a complete range of motion reported in all patients. There was no limping/misalignment or gait disturbances reported at the end of follow up in any of the patients. Conclusion: Stener-type lesion of knee is rare and is needed to be explored further. Our study emphasizes the early diagnosis and surgery with excellent results of cases reported in due course of time. Very limited literature is currently available for this severe sMCL injury. Thus, longer studies involving a larger number of cases and extended follow up are needed in future to explore the ways of early diagnosis and various treatment options further.