The deep MCL component (medial capsular ligament) tethers the medial meniscus peripherally through its meniscofemoral and meniscotibial fibres. It is injured in combined MCL-medial meniscal trauma. The meniscotibial component (coronary ligament) is also known as the deep MCL portion that anchors the medial meniscus body to the tibia. Its disruption produces the medial meniscal ramp lesion.
| Origin | Medial femoral condyle (just distal to the superficial MCL) |
|---|---|
| Insertion | Medial meniscus periphery (meniscofemoral and meniscotibial portions) |
| Actions | Anchors the medial meniscus to the femur and tibia; contributes to deep medial knee stability |
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Meniscal ramp lesions — posterior horn medial meniscal tears at the meniscocapsular junction — represent tears of the meniscotibial portion of the deep MCL and are associated with ACL injuries in 15-20% of cases. They are best seen through the posteromedial compartment with the 70-degree arthroscope and are repaired with inside-out or all-inside suture techniques at the same ACL reconstruction setting.
Posterior medial meniscocapsular tear at the deep MCL level associated with ACL injury managed with inside-out repair at ACL reconstruction.
