Medical Collateral Ligament Avulsion


Michael had a very interesting injury to his left knee in April 2017 while skiing. He was actually referred by another patient, and came to me with a delayed presentation.

He had had a very nasty tumble while skiing and had pulled off his medial collateral ligament, together with a large piece of bone. This is quite an unusual injury.

Avulsion of MCL

MRI view from the front - showing the unhealed fragment of bone

MCL avulsion

Xray view view from the front - showing the unhealed fragment of bone


He was seen locally and was managed conservatively (ie without surgery). Sadly, the bone fragment healed in the wrong position, and he had a very badly-functioning knee. His knee was grossly unstable and effectively he couldn't walk.

These injuries need to be managed aggressively. Therefore he underwent a reconstruction of his MCL under my care in June 2017. I was able to mobilise the bony fragment and was able to reattach it with a large fragment screw and then repair the ligament using the internal brace technique to hold that reconstruction such that we could get him going fairly aggressively.. You can see this on the postoperative X-rays where there is a button on the opposite side to where the screw starts, and this is suspending the internal brace which is holding his MCL in a good position for healing.​

repair MCL avulsion

After the surgery - view from the front

Repair MCL avulsion

After the surgery - view from the side

So you will see on the left hand X-ray a small button on the lateral (outside) aspect of the femur (blue arrow) - which is the button that was holding the internal brace - and also of course you can see the screw and washer, which is what I fixed the medial collateral ligament back with.

MUA November 2017

We had to do a manipulation-under-anaesthesia (MUA) which is not uncommon in these cases - which he underwent back in November. This gave him his movement back such that he regained full movement in the knee.

Follow-up December 2017

I was delighted to see him today - he says he has just been up Snowdon and he can walk miles. His knee feels beautifully stable and he is doing extremely well.

Follow-up March 2018

I am delighted that he has got back to the point now where the knee feels perfectly stable and he can hike and is confident enough to go skiing in four weeks time. And he is delighted with his outcome.

He has a little irritation from the screw which we will remove but other than this mild irritation he has made a full recovery.It was an interesting case. I think it is very useful to have techniques such as the new internal brace to allow us to get early mobilisation of these injuries and also to get a very good result.

The knee held up superbly in St Anton, in some tricky snow conditions. I even managed two days off piste with some serious locals to include some touring . I did wear the brace Adrian recommended."

Adrian Wilson

Adrian Wilson

This was again another great case where I have used the internal brace with a very good result and also managed to sort out quite a tricky situation with his MCL.The X-rays are fairly self-evident showing the screw and washer of the internal brace of the front view, and you can also see the side view as well.

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early 2018

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