Posteromedial Corner (PMC) Injuries Non-Surgical Treatment

Can a posteromedial corner injury be treated without surgery?

Isolated MCL tears commonly heal on their own because they have a very robust supply of blood flow and nutrients. Additionally, this ligament is outside the knee joint capsule (the lining of the joint). Proteins within the joint fluid inhibit healing, so therefore, being outside the joint is beneficial for healing. Moreover, on the inside, or medial aspect, of the knee, the convex (rounded) end of the femur articulates with a concave (bowl-shaped) tibia, which allows for a more stable joint. For these reasons, a PMC injury can also sometimes be treated without surgery. However, likely, surgery for a PMC injury will be required.

Non-operative treatment of PMC injuries involves a change in activities to avoid movements that cause knee pain, instability, and excessive valgus stress to the knee. Additional conservative treatment options include over-the-counter anti-inflammatory medications to reduce pain and inflammation, use of a hinged knee brace, and physical therapy. Typically, symptoms will resolve within 2-4 months of conservative, non-surgical treatment. If your knee pain is resolved with non-operative treatment and you can return to your desired level of activity, then no PMC surgery is needed.

However, there are two situations in which the MCL will not heal. First, if the knee gaps open on the inside when the knee is fully extended (valgus gapping in extension), the likelihood of the MCL healing without surgery is very low. The reason for this is that it is likely that both the MCL and POL are injured. The second type of injury requiring surgery is a tear of the MCL at the tibial attachment that retracts toward the knee. This is called a meniscotibial MCL tear. These types of tears also usually don’t heal on their own. This is because the torn and retracted MCL becomes trapped above the hamstring tendons, and it cannot heal back down to the tibia. In both types of injuries, the knee will feel very unstable to inward pressure (valgus force) when assessed by a physician.