Surgical Repair of Stener-like Lesion of the Medial Collateral Ligament of the Knee

Introduction: Superficial medial collateral ligament (sMCL) tears of the knee will usually be treated non-surgically. But in some cases such as those with tears at the distal insertion, where it may displace over the pes anserinus tendons (Stener-like lesion), surgery will be performed. Here, we describe a patient with acute traumatic Stener-like lesions of sMCL based on clinical evaluation and imaging results, who underwent primary surgical repair. Case Presentation: A 26 years old male patient was admitted to the outpatient clinic with a chief complaint of left knee pain after valgus trauma on the left knee while playing badminton 5 days prior. Clinical examination revealed a moderate swelling and there was tenderness on the medial joint line. The full knee flexion was restricted due to swelling. A valgus stress test showed laxity of the medial joint. The anterior drawer and Lachman test showed anterior laxity. A left knee joint aspiration was done and 45 cc of red cloudy synovial fluid was aspirated. On the MRI examination, a bunched MCL with a displacement of the tibial insertion site over the per anserinus tendons was identified, along with the complete rupture of the ACL. The patient underwent two-stage treatment : an arthroscopic ACL reconstruction and surgical repair of the MCL. After the surgery, the patient wore a knee brace fixed in full extension for 4 weeks. The patient also followed a standard ACL rehabilitation protocol. Follow up were done 6 months after the surgery. Results: At final follow-up, the patient had regained normal stability of the MCL without any laxity in comparison to the contralateral knee. The anterior drawer and Lachman test had returned to normal. Patient was completely pain-free and did not have any complaints of instability. Discussion: Surgical repair is indicated in specific circumstances such as a Stener-like lesion in which the interposition of the pes anserinus between the ligament impeding the healing process of MCL. Prompt surgical intervention can restore the anatomic position of the MCL, promote anatomic healing, and prevent long-term valgus instability. Conclusion: Stener-like lesion of the MCL are rare, and early diagnosis is important in treating this condition. Surgical treatment must be done to provide complete healing of the MCL.