Surgical Principles for Medial and Posteromedial Knee Injuries

Elsevier

Available online 14 March 2022, 150911

Operative Techniques in Sports MedicineAbstract

Injuries to the medial side of the knee are among the most common knee ligament injuries. Treatment of these injuries require a thorough clinical workup and an intricate knowledge of the anatomy and biomechanics involving this region of the knee. Low grade injuries and isolated injuries to the medial collateral ligament (MCL) are treated nonoperatively with bracing and functional rehabilitation. Surgical treatment is recommended for high grade (Grade III) posteromedial corner injuries, distal MCL tears, including Stener lesions, knee dislocations and multiple ligament knee injuries involving the posterolateral corner (PLC) because of high risk of residual instability if treated non-operatively. When indicated, surgical treatment should be performed in the acute phase followed by early protected range of motion and functional rehabilitation. Preoperative planning should include stress radiographs and MRI. Important considerations for surgical technique include avoiding graft tunnel convergence in the setting of multiple ligament reconstruction and anatomic placement of the tunnels to recreate the native kinematics of the medial compartment. Postoperative rehabilitation focusing on quadriceps activation and protected range of motion is recommended beginning postoperative day one to minimize the risk of arthrofibrosis. Anatomic reconstruction of the superficial medial collateral ligament and posterior oblique ligament have been shown to produce good subjective and objective patient outcomes. Further level one studies are recommended to reinforce these findings.

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