The deep MCL (deep medial collateral ligament, also called the medial capsular ligament or mid-third medial capsular ligament) is a thickening of the medial knee capsule lying deep to the superficial MCL. It is composed of the meniscofemoral and meniscotibial (coronary) ligaments: the meniscotibial portion connects the medial meniscus periphery to the tibia, limiting meniscal translation, and the meniscofemoral portion connects the medial meniscus to the femur. Together they form the deep layer of the medial ligamentous complex.
| Origin | Medial femoral condyle just distal to the medial epicondyle (meniscofemoral portion) |
|---|---|
| Insertion | Periphery of the medial meniscus and the medial tibial plateau just below the joint line (meniscotibial portion) |
Resists medial compartment opening to valgus stress at full extension, limits medial meniscal posterior translation, and contributes to rotational stability in combination with the superficial MCL.
The deep MCL is disrupted in high-grade medial knee injuries, producing the characteristic combined medial meniscus and MCL injury pattern; grade III MCL injuries usually involve both layers. Deep MCL tears allow the medial meniscus to translate further than normal, contributing to medial meniscal pathology in ACL-deficient knees. Tears of its posterior meniscotibial portion form meniscal ramp lesions, which accompany a notable proportion of ACL injuries and are best seen through a posteromedial arthroscopic view. MRI distinguishes deep from superficial MCL tears. In medial-sided knee surgery the deep layer is identified separately from the superficial MCL.
High-grade valgus knee injury disrupts both the superficial and deep MCL, producing medial instability that may not fully respond to MCL healing alone; combined repair or reconstruction may be needed in grade III injuries with associated ACL disruption.
Tear at the posterior meniscocapsular (meniscotibial) junction of the medial meniscus associated with ACL injury, often missed on MRI and repaired with suture techniques at the time of ACL reconstruction.
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