Fourth-time MCL reconstruction

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Scott is an amazing case. He is a 40 year old lawyer who came to see me in 2016 with a complex right knee issue.

Three failed MCL reconstructions

He first injured his knee playing rugby aged 21 and had a combined ACL and MCL rupture. He went on to have both reconstructed in London but sadly his knee never felt the same and he just decided to put up with it.

He modified his life and gave up rugby and took up squash, but when twisting and playing squash his MCL wasn't up to the task and gave way and he had to then seek a further opinion. He saw a surgeon in London who undertook a revision MCL procedure which again failed.

Then he had a third MCL reconstruction which also failed!

Fourth opinion!

He decided to get a further opinion and came to see me in 2016 because of my interest in complex ligament reconstruction.

I am particularly interested in the MCL, and the collateral ligament on the opposite side - the LCL, in terms of injury as I have developed a new way of tackling this particular injury by the use of an augmentation with a 2mm non-biodegradable tape, which I use in conjunction with the patient's own tissue (autograft) or allograft.

In Scott's case things were very interesting. When I opened up the medial side of his knee, the previous allograft was lax and non-functional but still present. I decided to use this to reconstruct the posterior (back part) of the MCL (or so-called posterior oblique ligament). I reinforced it with FiberTape and brought it down to a tunnel at the back of the tibia where the posterior oblique ligament inserts, and took it through that tunnel and fixed it then on the front of the tibia.

4th MCL revision

I then used a further allograft for the main superficial MCL, which again I reinforced.

Scott obviously had to take things very slowly and was in a brace for some time but by the end of the year I am glad to say that his knee began to feel normal. He has slowly got himself back into a very good level of activity. He has lost a stone and a half in weight and is training 2-3 times a week. He is doing a combination of both cardio and strength work and is comfortably running on a treadmill.

His knee is completely pain free and to him feels very stable. Although he is aware of his knee is doesn't really impede him now from doing anything. he is very sensible in terms of his activities and he quite wisely hasn't returned to twisting and turning sports, but can do everything else that he wants to enjoy.

Prior to seeing me he was really quite disabled with a non-functional MCL and a knee that was giving way and stopping him from walking even short distances.

adrian wilson

I think this case is a real triumph and a very good example of how new techniques and modern technology can really make the difference. The MCL is a particularly difficult ligament to reconstruct and one of the key learning points for young surgeons coming through is that you really need to understand the anatomy.

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