Medial Collateral Ligament Tear

A 51-year-old man-a 6 ft, 240 lb bodybuilder-presented with long-standing, chronic rotational instability of the left knee as the result of a valgus blow to the joint during a football game 20 years earlier. The patient complained of extreme pain and reported that he felt the tibia sliding around under the left femur.

Arthroscopic examination revealed a complete tear of the medial collateral ligament; the cruciate ligament and the medial meniscus were intact. A pes anserinus transfer was performed to repair the torn medial collateral ligament.

Thomas A. Keel, MS, OPA, of San Antonio, Tex, writes that the pes anserinus is the final common medial insertion of the sartorius, gracilis, and semitendinous muscles. The pes anserinus transfer involves moving part of the pes anserinus muscles anteriorly and reattaching the muscles to replace the damaged medial collateral ligament. Supporting medial femoral staples are visible in the films.

Following surgery, the patient reported that the knee was stable for flexion and extension and functioned well during routine activities of daily living and aerobic walking. However, the knee would collapse if vigorously rotated or stressed by direct force, such as jumping and landing on the left leg. Arthritis was the chief cause of his knee pain.

Mr Keel adds that a collateral ligament injury to the knee can lead to life-long knee disability, particularly during activities that cause complex multidirectional rotational instability.