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Reconstruction Of The Medial Collateral Ligament

Article written by: ANDREI BOGDAN, MD, Orthopedics-traumatology doctor

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For all traumatic or chronic diseases of the musculoskeletal system, the Centrokinetic private clinic in Bucharest is prepared with an integrated Orthopedic Department, which offers all the necessary services to the patient, from diagnosis to complete recovery.

The Department of Orthopedic Surgery of Centrokinetic is dedicated to providing excellent patient care and exceptional education for young physicians in the fields of orthopedic surgery and musculoskeletal medicine.

Centrokinetic attaches great importance to the entire medical act: investigations necessary for correct diagnosis (ultrasound, MRI), surgery, and postoperative recovery.

Discover the open MRI imaging center in our clinic. Centrokinetic has a state-of-the-art MRI machine, dedicated to musculoskeletal conditions, in the upper and lower limbs. The MRI machine is open so that people suffering from claustrophobia can do this investigation. The examination duration is, on average, 20 minutes.

Injury to the medial collateral ligament complex is one of the most common injuries in the medial area of the knee.

The medial collateral ligament complex, or MCL, extends from the end of the femur (thigh bone) to the upper tibia (calf bone) and is located inside the knee joint. There are three main anatomical structures in the medial part of the knee, the medial collateral superficial ligament being the largest and strongest. The other main structures are the posterior oblique ligament and the deep collateral ligament. It is important to remember as a definition, that the lesion of the medial collateral complex means the damage of all three structures.

A large number of single medial injuries (without association with other ligament injuries in the knee: LIA, LIP, MI) are due to sports injuries. An injury to the MCL complex can occur by applying stress to the side of the knee, which forces the knee into the valgus. This stretches or breaks the medial structures of the knee. This condition can be caused either by contact or without contact.

The diagnosis requires a clinical examination by which the medical team forces the knee in the lateral area and tries to see if there is instability in the medial area. We will perform both normal and stress radiographs and an MRI to assess the MCL area.

Classification of MCL lesions

The classification of damage to the medial collateral ligament complex is based on the number of ruptured fibers:

  • Grade I: occurs when there is only a slight rupture and there is no significant instability
  • Grade II: occurs if there is an injury, but instability is felt at valgus tension at 30 degrees knee flexion.
  • Grade III: occurs when there is a complete ligament rupture of the middle part of the knee and stress causes instability in both flexion and extension.

The worst grade I and II injuries will heal with a well-supervised recovery program. In grade III lesions, the situation is more complex, because there are lesions that heal if they are carefully monitored, but instead, others will not heal and patients may remain with residual instabilities.

MCL lesions are often associated with rupture of the anterior cruciate ligament (ACL) or posterior cruciate ligament (PCL).

The treatment algorithm in case of these complex lesions:

  • Acute LIA injury and grade III MCL (first 3-5 days after trauma): surgery is performed and MCL is repaired/sutured, and LIA is reconstructed/reinserted.
  • Chronic LIA injury and grade III MCL (after 6-8 weeks after trauma): if the patient arrives at our clinic after 10-14 days of trauma, we recommend a period of 6 weeks of recovery, the use of a mobile knee orthosis, and reassessment instability after this period. If the knee is stable from the MCL point of view, then we will only reconstruct the LIA. If it is unstable from the MCL point of view, then we will reconstruct both the LIA and the MCL complex.
  • PCL injury and grade III MCL: both ligaments are reconstructed simultaneously.

Even if MCL reconstruction is singular or associated with another surgical technique (LIA / LIP), all are performed in a single operating time, with spinal or general anesthesia and hospitalization for 24 hours.

The surgical reconstruction technique of the MCL complex aims at restoring all 3 ligaments: superficial, deep, and oblique posterior.

An incision of about 6 cm is made in the anteromedial area of the knee, the semitendinosus muscle is discovered and disinsulated proximal. Subsequently, the insertion site of the superficial medial collateral ligament is discovered, 6 cm below the articular interline, and the graft is fixed with 2 titanium anchors at this point. Then, place the third anchor 1.5 cm below the joint line.


The medial femoral epicondyle and the place of insertion of the MCL ligament on the femur are discovered, a channel 6mm in diameter and 25mm long is made and the graft is fixed in 30 degrees of flexion, with 1 7 / 25mm screw. Subsequently, the posteromedial area of the tibia is highlighted, under the gastrocnemius muscle and a 6 mm diameter canal is made to restore the posterior oblique ligament. The graft is fixed in this channel with 1 7 / 25mm screw, in full extension.

After the operation, the patient is fitted with an orthosis, ice and on the second day, the recovery begins.

How long does the recovery process take?

For acute isolated MCL injuries, most athletes can return to sports by multiplying the damage by two (in weeks) as a general time interval. Thus, an acute grade I MCL injury usually takes 1-2 weeks to heal, while a grade II injury takes 3-4 weeks to heal, and a complete grade III isolated MCL injury It usually takes 5-6 weeks for well-guided rehabilitation (sometimes 8 weeks in real-time). The use of knee protection crutches, it is also frequently recommended acute situation in which the knee is significantly unstable.

IFollowing any surgery, medical recovery plays an essential role in the social, professional, and family reintegration of the patient. Because we pursue the optimal outcome for each patient entering the clinic, recovery medicine from Centrokinetic is based on a team of experienced physicians and physical therapists and standardized medical protocols.

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