20Shoulder Care
AC Joint Injuries
Arthritis
Biceps Tendon Injuries
Calcific Tendinitis
Clavicle Fractures
Frozen Shoulder
Labral and SLAP Tears
Rotator Cuff Injuries
Shoulder Dislocation/Instability
Subacromial Impingement/Busitis
A-C Joint Stabilization
Biceps Tenodesis
Clavicle Fracture Fixation
Pectoralis Major Repair
Rotator Cuff Repair
Shoulder Instability Surgery – Bankart Repair
Shoulder Instability Surgery – Latarjet Procedure
Subacromial Decompression and Acromioplasty
Superior Capsular Reconstruction
Total Shoulder Replacement
28Knee Care
ACL Tear
Cartilage Injury
Lateral Meniscus Tear
LCL Injury
MCL Injury
Medial Meniscus Tear
Osteoarthritis
Patellar Instability
Patellofemoral Chondromalacia
Posterolateral Corner Injury
Trochlear Dysplasia
Anterior Cruciate Ligament (ACL) Reconstruction
Cartilage Restoration Surgery – Autologous Chondrocyte Implantation (ACI-Carticel)
Cartilage Restoration Surgery – Donor Graft
Collagen Meniscal Implant (CMI)
Lateral Collateral Ligament (LCL) Reconstruction
Medial Collateral Ligament (MCL) Reconstruction
Meniscus Repair
Meniscus Root Repair
Meniscal Transplant
Nanofracture
Osteochondral Allograft Transfer
Osteochondral Autograft Transfer (OATS)
Partial Meniscectomy
Posterior Cruciate Ligament (PCL) Reconstruction
Posterolateral Corner (PLC) Surgery
Tibial Tubercle Osteotomy
Trochleoplasty
17Hip Care
Cartilage Injury
Femoroacetabular Impingement (FAI)
Gluteal Tears
Hamstring Tears
Hip Instability
Labral Tears
Psoas Impingement (Internal Snapping Hip)
Trochanteric Bursitis
Acetabuloplasty
Chondroplasty
Femoroplasty
Gluteal Repair
Labral Debridement
Labral Repair
Labral Reconstruction
Nanofracture
Trochanteric Bursa Debridement
2Biologics
Bone Marrow Aspirate Stem Cell Concentrate (BMC)
Platelet-Rich Plasma “PRP”

MEDIAL COLLATERAL LIGAMENT (MCL) RECONSTRUCTION

The medial collateral ligament (MCL) is one of the four major ligaments in the knee. The MCL is on the inside of the knee and runs from the end of the femur (thigh bone) to the top of the tibia (shin bone). The primary role of the MCL is to provide knee stability in the frontal plane. The MCL is particularly important in providing stability to the knee when stress is placed on the outside of the knee, which places the MCL under tension. Too much stress can lead to an MCL sprain (tear). MCL injuries, like ACL injuries, are graded I-III (III most severe).

Most patients with Grade III MCL strains (complete tear) are treated non-operatively with a brace and physical therapy. Unlike the ACL, a completely torn MCL can heal on its own with appropriate tension. However, in some cases, the MCL does not heal and surgery may be required. This is common when patients tear both the ACL and the MCL. The goal of MCL surgery is to stabilize the knee. There are two ways to restore stability: either with a direct repair of the torn tissue or by replacing the torn MCL with healthier donor tissue (reconstruction). If a reconstruction is performed, Dr. Keller can use either healthy tissue from a cadaver (allograft tissue) or from the patient’s own body (autograft). The new tissue must be placed in the right position in the knee and must be tensioned appropriately to restore stability to the knee.

Multiple grafts (replacement tissue) are available to reconstruct the MCL or provide additional support to a direct repair of the torn MCL. Allografts include achilles tendon and hamstring, among others. Generally speaking, Dr. Keller prefers using allograft for MCL reconstruction.

Post-Operative Rehabilitation

Following surgery, patients are placed in a brace that is locked straight. When the patient is sitting or lying down, Dr. Keller encourages knee range of motion exercises with the brace removed. Dr. Keller also recommends intermittent icing and straight leg raise exercises to strengthen the quadriceps muscles. Dr. Keller recommends starting physical therapy one weeks after surgery. Physical therapy focuses on reducing swelling in the knee, restoring full range of motion, and eventually, restoring strength to the knee with particular emphasis placed on the quadriceps. Dr. Keller recommends advancing the physical therapy program to cutting, pivoting, and sport-specific activities only after the patient has achieved certain goals (for example, appropriate quadriceps strength, appropriate range of motion, etc.). Most patients start sport-specific training approximately 4-6 months after surgery. Most patients return to competitive sports approximately six months after surgery. It is very important to follow the rehabilitation process carefully to achieve the best outcome.