Deep medial collateral ligament (MCL) injury leads to meniscal lift-off and extrusion of the medial meniscus, resulting in instability and increased medial compartment pressures with subsequent cartilage damage. Repair of the deep MCL meniscotibial ligament in concert with superficial MCL repair or reconstruction is intended to restore the native anatomy , stability, and function of the medial meniscus. We present an arthroscopically assisted technique using standard arthroscopy portals and a medial open approach.
As the understanding of the intrinsic reliance of the anterior cruciate ligament on the medial collateral ligament (MCL) has grown, we have delved further into trying to understand what specific function needs to be restored in their combined injury. At the same time, we have expanded our knowledge of the relation between the MCL and the medial meniscus. It is a great step forward for our knowledge to begin to infer medial stability from the status of the medial meniscus in these complex cases. In my practice, this manifests as understanding that a floating meniscus indicates deep MCL injury, which makes me more likely to treat a moderate MCL injury operatively. I look forward to the continued understanding of the dynamic positioning of the medial meniscus and its treatment in combined anterior cruciate ligamenteMCL injuries.
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