Surgical repair for the Posterior Cruciate Ligament (PCL), Medial Collateral Ligament (MCL) and Lateral Collateral Ligament (LCL) is dependent on the severity of the injury and if it is chronic or acute. There are several different methods to repair/reconstruct the ligaments and the most common procedures are listed below:
Posterior Cruciate Ligament (PCL) Reconstruction
Similar to the ACL, a torn PCL is generally not amenable to repair in the majority of patients, so the surgery of choice is a ligament reconstruction. The PCL is reconstructed using a graft that can be obtained from the patient (autograft) or from a cadaver (allograft). Once the graft is prepared, it is inserted through tunnels created in the femur (thigh bone) and tibia (shin bone). The graft is secured in place in a variety of ways including screws, suture tension devices, and/or staples. There are several types of PCL grafts, the most common being a hamstring tendon graft (either autograft or allograft). Because the PCL is frequently torn in multiligament knee injuries, other factors must be considered while reconstructing the ligament to ensure that all of the damage in the knee is addressed. After surgery most patients may weight bear as tolerated with crutches and a brace. The brace is typically worn for 6-8 weeks. Intensive and dedicated physical therapy according to specified protocols is essential to obtain a good result and to allow return to full activity.
Medial Collateral Ligament (MCL) Repair/Reconstruction
Grade I and II tears of the MCL can heal on their own with nonoperative treatments. Grade III MCL tears are completely torn or detached from the bone and surgical repair/reconstruction may become necessary to restore stability. Almost all MCL injuries can be repaired without a complete reconstruction. MCL repairs are performed via an open incision on the inside of the knee and involve repairing the ligament with specialized suture anchors, reattaching the ligament to the bone at its native attachment site. If the MCL is not amenable to repair, or a chronic MCL tear continues to cause pain and instability, a ligament reconstruction similar to the technique for the ACL and PCL (see above) can be performed. Hamstring or achilles tendon graft are commonly used grafts for the MCL reconstruction. The graft is prepared and then inserted into tunnels created on the medial side (inside) of the femur (thigh bone) and tibia (shin bone). The graft is then secured with screws or other anchor devices. After surgery, patients are placed in a hinged knee brace and advised to limit or avoid weight bearing on the knee for 6-8 weeks. Therapy is started the day after surgery and full range of motion is allowed after 6 weeks. After the first 6 weeks, intensive therapy and strength training of the leg are recommended to obtain a good result and a return to full activity.
Lateral Collateral Ligament (LCL) Repair/Reconstruction
Surgical repair to the LCL is rarely considered unless the injury is a grade III tear and the injury involves more than just the LCL tear (a multi-ligament injury). If the injury is acute and the ligament has not had time to scar and retract, specialized sutures can be used in the operation to reattach the torn ligament. If the ligament has detached from the bone, suture anchors are used to secure the ligament and any other torn lateral tendons and ligaments back to the bone. If the injury is chronic, a ligament reconstruction similar to the technique for the other knee ligaments (see above) must be performed. In an LCL reconstruction, a hamstring autograft or allograft, or an Achilles tendon allograft are frequently used grafts. The graft is prepared and then inserted into tunnels created on the lateral side (outside) of the femur (thigh bone) and fibula (outside bone in the lower leg). The graft is then secured with a variety of screws and/or anchors. After surgery most patients may partially bear weight with crutches and a brace for 6-8 weeks. Intensive and dedicated physical therapy according to specified protocols is essential to obtain a good result and to allow return to full activity. Because the LCL is commonly repaired during multi-ligament injuries, the length of recovery is dependent on the other procedures that were performed during the operation.