Fourth-time MCL reconstruction


I originally tore my ACL and MCL when I got stamped on the side of my knee playing rugby when I was 21. This sadly ended my time playing rugby.

Following my first operation I continued to have problems with my MCL which forced me to switch to gym exercise and running as the instability in my knee prevented me from playing any sport involving in lateral knee movement such as football or rugby.

After 10 years I ended up seeing my second knee consultant who was highly regarded in the city and re-operated on my MCL . This did not fix my problem as I continued to have instability issues in my knee limiting me to only certain exercises. In 2013, knowing I was to become a father and wanting to be active with my kids I resulted in a third operation with the same consultant. At this point I made it very clear I did not expect a forth operation given the impact that recovery was having on my life. Interestingly at this time he made me aware I had a tear in my meniscus/cartilage which had not been previously highlighted which would explain why I had knee pain for so many years.

Sadly both the MCL and meniscus/cartilage failed (again!) making me lose trust in the orthopaedic profession. Not knowing where to turn I saw my local GP who referred to Prof Adrian Wilson based on excellent feedback from existing clients.

Fourth time success?

On meeting Prof Wilson I automatically warmed to him given how interpersonal he was and strong bedside manner (unlike the previous consultants). He also spent time talking me through my options given my history with 30 mins appointments unlike the 15 mins I had with previous consultants.

Prof Wilson operated in April 2016 and one year on I am making a strong recovery. I'll never be back playing rugby (I'm too old now!) but I am slowly building up my running (with no pain!) and starting to enjoy to enjoying playing sport and being active with my kids.

Adrian Wilson

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.

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

4th MCL revision

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.

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.

adrian wilson

Adrian Wilson

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.

Scott's case was amazing. He is a 40 year old working in the investment banking industry who came to see me in 2016 with a complex right knee issue.

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!

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

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