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Thread: MCL repair?

  1. #1
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    MCL repair?

    Here's the story. Torn ACL, severe bone bruising, a "dent" in the cartilage, and a very "loose"/torn MCL. Doc says he wants to go in the uninjured leg and take a a hamstring graft as well as cadaver hamstring to fix the acl as well as the mcl. Or something like that.

    My question is... when is it appropriate to fix an MCL? It isn't completely torn but doc is concerned about it being loose and putting the acl at risk in the future. And what about the cartilage dent?

    It seems fixing the MCL this way is going to make the rehab much longer and doesn't seem neccesary to me.

    ???

  2. #2
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    I treat the torn MCL with a cast for one month. At the end of the month, the cast is taken off and the MCL is tight as a new bride.

    Then prehab for about one month.

    Then a simple ACL reconstruction.

    MCL surgery is NEVER necessary.
    drmark
    Mark Sanders, MD FACS
    Certified by the American Board of Orthopaedic Surgery, Subspecialty Certificate in Orthopaedic Sports Medicine
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    Fellow of the American College of Surgeons
    www.sandersclinic.net
    Houston, Texas
    713.907.6076

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  3. #3
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    thanks, surgery is in 2 weeks. Can the mcl heal while rehabbing the ACL?

  4. #4
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    It does, but usually in an elongated positon. If the injury is new, it heals best in a cast.
    drmark
    Mark Sanders, MD FACS
    Certified by the American Board of Orthopaedic Surgery, Subspecialty Certificate in Orthopaedic Sports Medicine
    Fellow of the American Academy of Orthopaedic Surgeons
    Fellow of the American College of Surgeons
    www.sandersclinic.net
    Houston, Texas
    713.907.6076

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  5. #5
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    fineline WTF, you need to stop with the self brutalization already. Heal up chica.
    fighting gravity on a daily basis

    WhiteRoom Skis
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  6. #6
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    Thanks vin, but this is about someone else I am concerned with

    however... THIS x-ray was taken today of my poor little hand

  7. #7
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    good repair job.
    drmark
    Mark Sanders, MD FACS
    Certified by the American Board of Orthopaedic Surgery, Subspecialty Certificate in Orthopaedic Sports Medicine
    Fellow of the American Academy of Orthopaedic Surgeons
    Fellow of the American College of Surgeons
    www.sandersclinic.net
    Houston, Texas
    713.907.6076

    Terms & conditions of use, as it relates to any and all information posted to TGR.com's discussion forums by drmark can be found at:
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  8. #8
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    Quote Originally Posted by drmark View Post
    good repair job.
    good to hear! My doc said this was one of the most challenging hand repairs he has ever had to do- that when they opened me up the many bone pieces practically fell out onto the operating table.

  9. #9
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    Quote Originally Posted by fineline View Post
    Here's the story. Torn ACL, severe bone bruising, a "dent" in the cartilage, and a very "loose"/torn MCL. Doc says he wants to go in the uninjured leg and take a a hamstring graft as well as cadaver hamstring to fix the acl as well as the mcl. Or something like that.

    ???
    Sounds almost word for word like mine. During the initial consultation the ortho said the MCL -should- heal fine on its own but he would check it out during the surgery.


    8 weeks later, "The MCL looks great and the cartilage is completely normal for your age and activity level."

    Initial Injury Milestones:
    Dual Crutch 7 days
    4 strap hinged brace 24 days
    On day 17 I could spin a bike crank with the seat jacked up to max.

  10. #10
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    Quote Originally Posted by fineline View Post
    Thanks vin, but this is about someone else I am concerned with

    however... THIS x-ray was taken today of my poor little hand
    Ouch, how did you pull that off?

  11. #11
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    In foolish comp-mindset I hit a cliff too big for the tiny landing area and punched a rock. Just lucky it wasn't my head I guess. 2 months later, just got the 2 external pins pulled out- yay!

  12. #12
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    Question: I tweaked my knee one year ago. MRI states I have a torn MCL but not a serious one. However I have serious knee instability and my knee pops out every two weeks while walking. I have done serious PT, I mountain bike 3 to 4 days a week and its not helping. PT says my MCL is stretched out and MD's dont really address it because the MRI says slight tears and not calling it a type 2 or 3 but my knee really isnt right. I cant surf or skateboard... Please help....Advice??

    Mahalo,

    Hayden

  13. #13
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    I would be worried about another injury if you're truly feeling instability. For example, could the ACL have been stretched and be functionally lax now (i.e., didn't tear but stretched so it's functionally no longer acting to stabilize the knee)? First and foremost, what is your exam like? Is your knee unstable to "valgus stress" (opening up of the inside of the knee, which the MCL helps stabilize)? How does the ACL seem on exam?

    I did a quick Pubmed literature search, and one recent paper spoke of fixing isolated MCL injuries in professional football players because of a small subgroup that had persistent injury to the deep fibers where the ligament originates from the thigh bone (bear in mind that the standard clinical approach is not to fix an isolated MCL injury). But these professional athletes' symptom was persistent pain at the origin of the ligament, not instability like you, so this arguably may not apply to your case.

    With persistent instability my worry would be an insufficient ACL or something of the like. The ACL is at an angle and is not always seen quite as clearly on MRI as the PCL, and I've heard it said that it can also be stretched but not torn (which makes it functionally not wok because it's like a loose rope). I would go back to your physical exam and even consider a second opinion (don't worry, surgeons are not offended by this) if this persists to get new thoughts on the matter. Best of luck.
    Originally Posted by jm2e:
    To be a JONG is no curse in these unfortunate times. 'Tis better that than to be alone.

  14. #14
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    Thank you for your reply. ACL is intact. When my knee buckles, it goes from the inside. My concern is its been injured for a year and im worried about it being chronic.... I may follow drmark's advise and ask my surgeon about casting it.....

  15. #15
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    It's rare enough to hear about an isolated MCL injury resulting in persistent instability that I definitely agree with your predisposition to exhaust all non-operative approaches before ever considering surgery. The MCL is an "extra-articular ligament", meaning it resides outside the knee joint itself and therefore generally heals quite well. Maybe consider a second opinion at a high-volume place/major medical center that is exposed to such non-standard presentations?
    Originally Posted by jm2e:
    To be a JONG is no curse in these unfortunate times. 'Tis better that than to be alone.

  16. #16
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    MCL on my mind today (more than I wish it was). Did an MRI today and the MCL is not pretty.
    We knew it was a grade 3, along with my ACL grade 3.

    Doc Cunningham was hoping it was detached near the femur and could simply be tacked back to the bone during the ACL reconstruction, but no luck. It is snapped down low, looking frayed a bit. Doc said it *may* be able to be reattached to the tibia, but may need a cadaver allograft to heal properly. He was fairly confident this would work, but not 100%.
    To complicate things there is a small tibial plateau fracture that is leading to a lot of swelling, so the surgery will have to wait a few weeks, which apparently isnt good for the likelyhood of my MCL working well for the reconstruction. All this left me feeling very uneasy. Beyond a second ortho opinion, any thoughts?

  17. #17
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    I had a pretty serious MCL tear in '02 or '03. For about a year or so afterwards it never felt solid. It took another year-at least- until it was solid again. I still wear grade II MCL braces when I ski.
    "Don't tell fish stories where the people know you; but particularly, don't tell them where they know fish" -Mark Twain

  18. #18
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    Quote Originally Posted by skiing-in-jackson View Post
    I had a pretty serious MCL tear in '02 or '03. For about a year or so afterwards it never felt solid. It took another year-at least- until it was solid again. I still wear grade II MCL braces when I ski.
    what type of procedure did your surgeon use to repair the MCL? my doc was a little concerned that the MCL could end up loose given the ugliness of my tear. he gave it a 90% success rate, but that still seemed like a lot of room for problems. one other question- how long post injury was your surgery?

  19. #19
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    Question ACL / MCL repair - help please?

    Fell skiing 6 weeks ago.
    MRI showed gr 3 MCL tear - High grade/complete ACL tear and a non-displaced fracture to my tibial plateau.
    I started physio 4 days after my fall, was in a zimmer splint and on crutches for a few weeks, then was fitted for a DonJoy brace. I can now walk slowly without the brace, but was told to wear it unless I was sitting in the couch, showering or sleeping. Physio says I have 75 % improvement with my MCL. However, I met the ortho surgeon today who was recommended to me, and said he wants me to see another ortho surgeon for his opinion, because he feels if the MCL isn't also repaired the ACL repair may fail. The idea of having a cadaver donation to repair the MCL is seriously freaking me out. The ACL repair they said is using my hamstring. Is there no alternative for an MCL repair other than using cadaver tissue???

    I would be so grateful for any advice.

    Thank you.

  20. #20
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    I ended up having my MCL reconstructed using my hamstring tendon. That left my patellar tendon to reconstruct the ACL. One big ugly operation, resulting in one big ugly swollen knee. I feel really good about it though, and glad to now be on the road to recovery. Operation done with Dr LaPrade in Vail. Top class. Doc said cadaver tissue does not work well for the MCL reconstruction, hence the decision to use my hamstring tendon. Not a simple procedure, but standard practice for LaPrade.

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