MCL Repair vs MCL Reconstruction: Which Surgery is Necessary?

We return today with Dr. Brett Owens to shift our discussion of MCL tears on to the treatment of isolated and combined MCL injuries, then wrap up with a discussion on safe return to play.

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Our conversation picks back up with a level 1 prospective multicenter RCT from the March 2022 issue of AJSM titled “Comparative Outcomes Occur After Superficial Medial Collateral Ligament Augmented Repair vs. Reconstruction.” Fifty-four patients with grade III MCL injuries were randomized to either MCL augmented repair or MCL reconstruction using a free semitendinosus autograft. At 1-year post-op, there was no difference in objective outcomes (including gapping on post-op valgus stress x-rays). However, patient-reported outcomes – including IKDC scores and Lysholm scores – favored reconstruction.

We finish up today with an article from the March issue of AJSM this year titled “Nonoperative Management, Repair, or Reconstruction of the Medial Collateral Ligament in Combined Anterior Cruciate and Medial Collateral Ligament Injuries – Which Is Best?” This systematic review and meta-analysis investigated the outcomes of three different approaches to ACL-MCL combined injuries: ACL reconstruction with either (1) non-op treatment of the MCL tear, (2) MCL repair, (3) MCL reconstruction.

There was no difference in patient-reported outcomes, range of motion and quadriceps strength at final follow up. The rate of arthrofibrosis was similar between non-op and surgically treated MCL injuries, and the authors note that this rate has steadily decreased, likely relating to advancement in surgical technique.

Author

Dr. Catherine Logan, MD, MBA Catherine Logan, MD, MBA, MSPT, is a sports medicine orthopaedic surgeon specializing in complex knee and shoulder surgery at Colorado Sports Medicine and Orthopaedics (COSMO) in Denver, Colorado. As a former physical therapist & trainer, Dr. Logan provides a distinct expertise in sports injury, prevention, and surgical management.