Medial collateral ligament reconstruction replaces a torn MCL with a tendon graft, restoring valgus stability to the knee. Most isolated MCL injuries heal with non-surgical treatment, so MCL reconstruction is uncommon in isolation. The procedure is most often performed for chronic MCL insufficiency that has failed non-surgical management or for combined ligament injuries where the MCL must be reconstructed alongside ACL or other ligament repairs.
What Is MCL Reconstruction?
The MCL is a broad ligament complex on the inner side of the knee, running from the medial epicondyle of the femur to the medial tibia. It resists valgus force (a force pushing the knee inward) and provides secondary restraint against external rotation.
Most acute MCL tears (grade I, II, and many grade III) heal with bracing and rehabilitation because the MCL has a robust blood supply. When healing fails or chronic insufficiency develops, reconstruction with a tendon graft restores the function of the torn ligament. The graft (typically allograft or hamstring autograft) is secured in bone tunnels at the native MCL attachments on the femur and tibia.
Who Is a Candidate?
Candidates for MCL reconstruction typically have:
- Chronic grade III MCL insufficiency that has failed non-surgical treatment
- Combined ACL and high-grade MCL injury, where simultaneous reconstruction is needed
- Multi-ligament knee injury with MCL involvement
- Bony Stener-like lesion where the torn MCL is displaced into the joint and cannot heal
- Active patients with persistent valgus instability that interferes with sport, work, or daily activity
Acute isolated grade I, II, and most grade III MCL injuries are treated non-surgically and rarely require reconstruction.
How the Procedure Is Performed
The procedure is performed through a small incision on the medial side of the knee. The torn or insufficient MCL is identified and the native attachments on the femur and tibia are exposed.
A tendon graft is prepared (typically allograft or hamstring autograft). Bone tunnels or anchor points are created at the native MCL footprints. The graft is secured to the femur and tibia with interference screws, cortical buttons, or suture anchors.
For combined ACL and MCL injuries, the ACL reconstruction is performed arthroscopically and the MCL repair or reconstruction is performed through the additional medial incision.
Recovery and Rehabilitation
Recovery is more protected when MCL reconstruction is performed:
- Hinged brace for six weeks with controlled motion
- Protected weight-bearing initially
- Range of motion exercises within safe limits during the first month
- Progressive strengthening at six to eight weeks
- Return to sport at five to seven months for isolated reconstruction, longer when combined with other ligament procedures
Risks and Outcomes
Risks include stiffness (more common after combined procedures), graft failure, saphenous nerve irritation, and persistent instability. Outcomes for isolated MCL reconstruction are good when the diagnosis and indications are clear. Combined-injury outcomes depend on all involved structures.
Why Dr. Chudik for MCL Reconstruction
Dr. Chudik treats the full spectrum of medial-sided knee injury, from acute MCL tears managed non-surgically to chronic insufficiency and complex combined-ligament reconstructions. His experience across the spectrum of cruciate and collateral ligament surgery allows precise sequencing of repair and reconstruction in multi-ligament cases.