MCL Injury

Isolated medial Collateral ligament is not so common even if they are less severe. Complete injury is always associated with ACL injury and most of the time the need to reconstruct along with ACL reconstruction. If the surgery is being done within 3 weeks of injury, then the ligament can be repaired with suture but if it is a late surgery then it needs to be reconstructed with tendon graft.

Posterolateral corner (PLC) Injury/Instability:

It’s a ligament complex that provides rotatory stability of the knee. These include lateral collateral ligament, posterolateral joint capsule, and popliteus muscle. Posterolateral corner injury/instability (PLC) is the deficiency of this ligament structure, basically a lateral knee instability. Mechanism of injury is varus and internal rotation force on leg in hyper extended knee. Isolated PLC injury is not common, 25%-28% cases it can be an isolated injury. It happens commonly with PCL injury but also can happen with ACL injury. This injury heals very poorly with conservative treatment. Only minor injuries G I & G II can be managed conservatively. If this is treated within 3 weeks of injury, then the tourn structure can be sutured end to end but after 3 weeks they need to be repaired with tendon graft. Sometimes high-grade PLC injury can be associated with foot drop due to peroneal nerve injury, which is located at that corner adjacent to the knee joint and neuropraxia due to lateral joint opening.

Medial patellofemoral ligament (MPFL) injury:

MPFL is not a true ligament, it is condensation of the joint capsule creating a ligament like structure from medial border of patella to medial rotatory axis point of femur near medial epicondyle. MPFL injury commonly associated with osteochondral injury of patella. Pre-existing developmental issues of the knee like trochlear dysplasia, patella alta, external tibial torsion can increase the possibility of this injury. MPFL injuries always require repair or reconstruction. Osteochondral injury of patella requires fixation but if it is a thin layer of cartilage then fixation is not possible. Sometimes other bony procedures need to be done conjointly to stabilize patella.

Multi Ligament Injury:

When more than one ligament gets injured in a knee injury it is called multiligament injury. Multiligament injury is not uncommon. Most common combinations are:

• ACL with MCL
• ACL with PLC
• PCL with PLC