The medial collateral ligament (MCL) is one of the four major ligaments of the knee. It is a broad, flat, membranous band, situated slightly posterior (back) on the medial (inner) side of the knee joint. It resists forces that would push the knee medially, which would otherwise produce valgus deformity, commonly referred to as "knock-knee." MCL tears often occur from soccer, skiing, or football and involve the joint being bent to the side, tearing the ligament that exists just inside the soft tissue of the knee. The MCL usually tears partially and is often graded as a Grade 1, 2 or 3 type of tear. Fortunately, the MCL has a very good blood supply. By protecting and rehabilitating it early with gentle range-of-motion exercises, soft tissue massage, and specific strengthening exercises, the tissue can be induced to heal in a relatively normal pattern with collagen fibers aligned along the normal pathway of the original MCL. Surgical repair of the MCL, in our opinion, is infrequently needed because the MCL will often heal. Occasionally, MCL injuries lead to chronic instability and in those cases we rebuild the MCL typically using an allograft or donor tissue to augment the suture repair of the ligament itself.
To cut, or not to cut? To repair, or to let heal? To rehab without fixing? To live with imperfect parts? Each of these questions is faced every day by surgeons and their patients. Here are a few decisions about incisions.
Gluten-free, vegan, dairy-free…all these variations of diets originally designed to address irritable bowels are exploding—apparently, because people’s bowels are now explosive. Celiac, diverticulitis, irritable bowel syndrome, and their relatives are being diagnosed more frequently than ever. As a society, Americans are becoming both more mindful and more stressed. Could these be linked through the gut?
Top skier breaks her leg. Doctor fixes it, gives her narcotics, and sends her home. She’s told to come back in two weeks for a checkup and have the rod taken out in a year. Doctor moves on to the next patient. What is wrong with this picture?