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Medial Collateral Ligament Repair via Internal Bracing

March 01, 2019

Contributors: Christopher S Ahmad, MD, FAAOS; George Popa; Hasani Swindell, MD; David Trofa, MD; Julian Sonnenfeld, MD; Julian Sonnenfeld, MD

The medial collateral ligament (MCL) is commonly injured in patients with an anterior cruciate ligament (ACL) injury. Given the favorable healing potential of the MCL, valgus instability often is managed nonsurgically depending on the integrity of the MCL. Typically, nonsurgical management consists of early protected range of motion and progressive strengthening, which results in a relatively successful return to preinjury levels of function. A lack of consensus exists with regard to the optimal treatment strategy for the management of partial and complete MCL tears. In addition, controversy exists with regard to whether MCL tears should be managed in the acute setting via repair or in a staged setting via reconstruction. Surgical treatment may be indicated in patients with an increased risk of injury to a newly reconstructed ACL. Surgical options to address high-grade MCL tears include primary repair, reconstruction, and augmentation strategies to restore valgus stability. Often, delayed management may increase the risk of prolonged quadriceps atrophy, resulting in residual laxity and an increased risk of ACL rerupture. Recently, interest has increased in the management of MCL injuries in the acute setting because it allows for faster recovery, earlier return to athletic activity, and earlier improvement in range of motion. This video demonstrates the use of an internal brace to aid in MCL healing in a competitive athlete undergoing ACL reconstruction. The video reviews the patient’s history, presentation, and imaging studies and discusses the technique, rehabilitation protocol, and clinical outcomes. The video includes a specific focus on surgical anatomy, including pearls and pitfalls to ensure appropriate isometry of MCL augmentation.

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