Primary Repair of the Medial Collateral Ligament With Internal Bracing

Abstract

The medial collateral ligament (MCL) is commonly injured in the setting of anterior cruciate ligament (ACL) injuries. Because the MCL has better healing capacity than the ACL, the general perception is that MCL injuries can be treated conservatively. Treating these injuries conservatively, however, can lead to residual valgus laxity. Furthermore, it delays time to surgery, which prevents acute treatment of concomitant ACL injuries using primary repair or acute reconstruction. Several treatment methods for MCL injuries have been proposed, including primary repair, augmented repair with autograft tissue, or primary reconstruction. In this surgical technique article, we present the technique of acute primary MCL repair with internal bracing with 2 limited incisions. With this technique, early surgical intervention is possible, and early rehabilitation is safe because of the internal bracing. Advantages include fast recovery, avoidance of muscle atrophy because of early mobilization, prevention of residual valgus instability, and maintenance of proprioception.

Fig 1

(A) Coronal T2-weighted image of the right knee showing a femoral tear of the medial collateral ligament (arrow). (B) View on the medial side of a right knee in 90° of flexion. The proximal stump of the medial collateral ligament (asterisk) and the distal avulsed ligament (arrow) can be seen. At the bottom right corner, the PassPort cannula (Arthrex) (hash sign) can be seen from the arthroscopic primary anterior cruciate ligament repair.

Fig 2

(A) View on the medial side of a left knee in 90° of flexion. The medial collateral ligament is now repaired (asterisk) with a suture anchor and repair stitches (remaining repair stitches [hash sign] need to be cut short), and the FiberTape internal brace (arrow) can be used to reinforce the repair. (B) View on the medial side of a right knee in 70° of flexion. The clamp is channeled from the distal wound to the proximal wound, and the tip of the clamp (arrow) is visible. The FiberTape (asterisk) is grabbed with the clamp and channeled distally.

Fig 3

(A) View on the medial side of a right knee in 20° to 30° of flexion. The FiberTape internal brace is now channeled under the skin bridge, and a suture anchor (arrow) is used to fix the FiberTape on the anteromedial side of the tibia. The PassPort cannula (hash sign) of the primary anterior cruciate ligament repair can be seen. (B) View on the medial side of a right knee in full extension. The suture anchor is partially deployed in the tibia after the FiberTape has been tensioned (arrow), and the knee is now ranged through its range of motion to assess any overconstraint of the knee. The PassPort cannula (hash sign) of the primary anterior cruciate ligament repair can be seen.