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How I Reconstruct the MCL (Medial Collateral Ligament)
In this video, I walk you through a medial collateral ligament (MCL) reconstruction using hamstring tendons.
Preparing the graft
I start by stripping the hamstring tendon, leaving its distal end attached to the tibia. Keeping this native attachment intact where possible helps preserve the tendon's biology.
I may then create a redirectional suture, repositioning the tendon so it runs in a more anatomical line — closer to where the native MCL itself would sit.
If the hamstrings have already been used for an ACL reconstruction in the same knee, they're no longer available as a graft source here. In that situation, I use an alternative graft — most commonly the rectus femoris tendon — to carry out the same reconstruction shown in this video, with an additional fixation point on the tibia to secure it.
Finding the femoral insertion point
Using image intensifier (live X-ray) guidance, I identify the correct femoral insertion point for the ligament. Getting this position right is essential, since it determines how the reconstructed ligament will tension through the knee's range of motion. I then create a channel across the femur (thigh bone) at this point.
Sizing and preparing the socket
Back at the graft, I prepare it with sutures and measure its diameter. That measurement then guides the size of the femoral socket I create in the thigh bone, ensuring the graft will sit snugly once passed through.
Passing the graft
The graft is passed through the soft tissue plane and then into the femoral socket, again under image intensifier guidance, to confirm the fixation button seats accurately on the thigh bone.
Fixing the tibial side
On the tibial side, I create a tunnel for a suture anchor, securing the other end of the graft and completing the reconstruction.
The result is a newly reconstructed MCL, restoring the knee's resistance to the sideways forces the native ligament was there to control.
If you have any other questions, feel free to drop me a message.