Arthroscopy
MCL (MEDIAL COLLATERAL LIGAMENT)
The medial collateral ligament (MCL) is the main stabilizing ligament on the knee's inner aspect. Its main function is to prevent the knee from buckling inward/knock-knee (valgus motion). Tears/ruptures of the ligament result in knee instability.
Causes
MCL tears are typically caused by trauma. A direct force to the outside of the knee stresses the ligament. This typically occurs in collision sports like football. Overuse injuries in sports/occupations requiring repetitive falling to the knees and standing up quickly can also lead to the ligament's micro-tears.
Symptoms
MCL tears cause immediate pain and often swelling. You may feel something “pop” on the inside aspect of the knee. Pain is centralised over the ligament (the inside aspect of the knee). Walking after the injury may be possible, but the knee may feel like it’s going to “give in” depending on the severity of the tear. The MCL is attached to the underlying meniscus. Damage to the meniscus at the time of injury may cause clicking or locking of the knee.
Diagnosis
Your surgeon will perform a thorough history and physical exam with X-rays. On exam, swelling and loss of motion and strength are present. Your surgeon will perform manoeuvres to check the stability of all the knee ligaments and the meniscus. An MRI is helpful to confirm the diagnosis, showing the MCL tear. The type of tear (partial, complete, avulsion from either the tibia or femur) can be defined, which may assist in treatment planning. The MRI may also show bruising bone secondary to the injury.
Treatment
Non-operative
Almost all minor MCL tears can be treated non-operatively. Non-operative treatment consisting of bracing, anti-inflammatory medication, physical therapy, cryotherapy and activity modification may be prescribed to decrease the swelling, regain motion and strength. Most patients may be able to return to regular exercise without surgery, depending on the tear's type and severity. A brace may be prescribed to return to sports activities. If symptoms persist (pain, instability), reconstruction surgery may be recommended by your surgeon.
Operative
Operative management of MCL tears depends on the type of tear. MCL repair may be indicated in patients where the MCL is torn off the femur wall (thigh bone) or tibia (shin bone. MCL repair is accomplished through a series of small incisions and sewed back into place and fixed with screws or buttons. The repair may also be supplemented with high-strength suture. If formal reconstruction is required, a new MCL graft will be fixed in place of the original ligament. A technique for graft placement and graft choice is a shared decision between you and your surgeon. Most techniques are performed through a minimally-invasive incision. The graft can be taken from around your knee or from a donor. Postoperative rehabilitation, return to daily activities and return to sport depends on the technique and graft chosen, and is at your surgeon’s discretion.
LCL (LATERAL COLLATERAL LIGAMENT)
The lateral collateral ligament (LCL) is the main stabilising ligament on the knee's outer aspect. Its main function is to prevent the knee from giving way outward (varus motion). Tears/ruptures of the ligament result in knee instability.
Causes
Isolated LCL tears are uncommon. They typically occur from trauma. A direct force to the inside of the knee stresses the ligament. This typically occurs in collision sports like football. LCL tears are also seen in high-energy trauma like motor vehicle accidents. Tears accompany them in the other ligaments and tendons outside the knee (aka – posterolateral corner injury and knee dislocation).
Symptoms
LCL tears cause immediate pain and often swelling. You may feel something “pop” on the outer aspect of the knee. Pain is centralised over the ligament (the outside aspect of the knee). Walking after the injury may be possible, but the knee may feel like it’s going to “give out” depending on the severity of the tear.
Diagnosis
Your surgeon will perform a thorough history and physical exam with X-rays. On exam, swelling and loss of motion and strength are present. Your surgeon will perform manoeuvres to check the stability of all the knee ligaments and the meniscus. An MRI is helpful to confirm the diagnosis, showing the LCL tear. The type of tear (partial, complete, avulsion from either the tibia or femur) can be defined, which may assist in treatment planning. The MRI may also show bruising bone secondary to the injury.
Treatment
Non-operative
Almost all minor LCL tears can be treated non-operatively. Non-operative treatment consisting of bracing, anti-inflammatory medication, physical therapy, cryotherapy and activity modification may be prescribed to decrease the swelling, regain motion and strength. Most patients may return to normal activity without surgery, depending on the type and severity of the tear. A brace may be prescribed to return to sports activities. If symptoms persist (pain, instability), reconstruction surgery may be recommended by your surgeon. If other structures are damaged (i.e., Posterolateral Corner), surgery is recommended to reconstruct the knee.
Operative
Operative management of LCL tears depends on the type of tear. LCL repair may be indicated in patients where the LCL is torn off the femur wall (thigh bone) or tibia (shin bone. LCL repair is accomplished through small incisions and sewed back into place and fixed with screws or buttons. The repair may also be supplemented with high-strength suture. If formal reconstruction is required, a new LCL graft will be fixed in place of the original ligament. A technique for graft placement and graft choice is a shared decision between you and your surgeon. Most procedures are performed through a minimally-invasive incision. The graft can be taken from around your knee or from a donor. Postoperative rehabilitation, return to daily activities and return to sport depends on the technique and graft chosen, and is at your surgeon’s discretion.
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PLC (POSTEROLATERAL CORNER)
Although rare, posterolateral corner (PLC) injuries can result in sustained instability and failed cruciate ligament reconstruction if they are not diagnosed.
The anatomy of the PLC was once thought to be perplexing and esoteric—in part because of the varying terminology applied to this region in the literature, which added unnecessary complexity. More recently, three major structures have been described as the primary stabilisers of the PLC based on biomechanical study findings: the lateral collateral ligament, popliteus tendon, and popliteofibular ligament. Other structures stated to be in the posterolateral ligamentous complex include the short and long heads tendons of the biceps femoris muscle, arcuate ligament, meniscopopliteal fascicles, and fabellofibular ligament. The PLC structures are primarily responsible for resisting; Varus angulation sometimes referred to as various rotation and external tibial rotation. They act as secondary stabilisers in conjunction with cruciate ligament, to prevent anterior and posterior translation. During the early phase of flexion (0-30*).