What are the relative indications for early surgical intervention in MCL injuries?
Stener-like lesion (Taketomi type 2): MCL interposed by pes anserinus—this must be a tibial-sided tear (which is rare)
MCL interposed in joint (Taketomi type 3)
Displaced bony avulsions
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What are the surgical options for MCL reconstruction?
Surgical options include:
Single-bundle or non-anatomical double-bundle (one femoral attachment)
Anatomical double-bundle (two femoral attachments) reconstructions. These primarily aim to repair the superficial MCL, with potential consideration for the posterior oblique ligament.
How should the MCL tear be managed in cases of concomitant ACL tears?
Classically, MCL is treated conservatively in a brace for 6 weeks before ACL reconstruction. If still lax, then consider concomitant reconstruction.
Shelbourne et al. (1992) reported good to excellent outcomes in a series of 84 patients with non-operative treatment for MCL and operative treatment for ACL. Concomitant reconstruction led to a higher incidence of stiffness.
I personally will consider early surgery for Nakamura Type 3 or Type 2 tibial-sided Stener lesions.
In Nakamura's study, 90% of Type 1 injuries regained stability with non-operative MCL treatment, while no Type 3 (diffuse tear) regained stability. → Recommend surgery for Type 3.