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The medial collateral ligament (MCL) and the posterior oblique ligament (POL) are the main static valgus restraints of the knee.
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Most isolated medial injuries can be treated with bracing and early knee motion.
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Combined MCL and ACL (anterior cruciate ligament) injuries can be managed with bracing of the knee followed by a delayed reconstruction of the ACL.
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Residual medial laxity may be addressed at the time of ACL surgery.
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Bony avulsions, incarceration of the distal MCL under the meniscus or over the pes anserinus tendons, open injuries, MCL tears combined with PCL or bi-cruciate injuries should be treated surgically.
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Chronic symptomatic medial instability can be managed with the recently described reconstruction techniques using free tendon grafts located at anatomical insertion sites.
Cite this article: Tandogan NR, Kayaalp A. Surgical treatment of medial knee ligament injuries: Current indications and techniques. EFORT Open Rev 2016;2:27-33. DOI: 10.1302/2058-5241.1.000007.
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Surgical intervention is the treatment of choice for recurrent lateral patellar instability.
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Surgery should be considered for first time lateral patella dislocations with osteochondral fractures or underlying anatomical risk factors.
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Primary repair and nonanatomical imbrications/reconstructions have fallen out of favor due to abnormal biomechanics and high rates of recurrence. Anatomical reconstruction of the MPFL using a variety of auto and allograft tissues have yielded good outcomes and low redislocation rates.
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Physeal sparing MPFL reconstruction techniques under radiological control are safe and do not cause growth disturbance. Allografts may be indicated for hyperlax patients.
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Although no clear cutoff points exist, correction of valgus and excessive femoral anteversion should be considered when indicated.
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Osteochondral and chondral injuries are common and should be addressed during surgery for instability.
Ortoklinik & Cankaya Orthopedics, Ankara, Turkey
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Avcilar Hospital, Istanbul, Turkey
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Ortoklinik & Cankaya Orthopedics, Ankara, Turkey
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Native patellar tendon injuries are seen in younger patients compared to quadriceps tendon ruptures.
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Up to a third of the patients may have local (antecedent tendinopathy and cortisone injections) or systemic risk factors (obesity, diabetes, hyperparathyroidism, chronic renal failure, fluoroquinolone or statin use) of injury, these are more frequent in bilateral disruptions.
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Complete extensor mechanism disruptions should be repaired surgically. Although isolated primary repair has been reported to have good outcomes in younger patients with acute tears and good tendon quality, augmentation of the repair with autograft, allograft or synthetic material should be considered in patients with poor tendon quality, chronic tears or tendon defects.
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High rates of return to work/sports have been reported in native patellar and quadriceps tendon tears, with re-rupture rates <5%.
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Extensor mechanism disruptions in patients with a total knee arthroplasty are challenging due to older age, systemic co-morbidities and poor local conditions, resulting in inferior outcomes compared to native extensor mechanism injuries. Some form of augmentation with autograft, allograft or synthetics is advisable in all cases. Salvage procedures such as whole extensor mechanism allografts provide acceptable outcomes in multiply operated knees with extensive bone and soft tissue deficits.
