Table 1.

Pearls and Pitfalls of MCL Trephination

Pearls	Pitfalls
Trephinate only the amount required for adequate visualization.	Overaggressive trephination risks valgus instability.
With a slight valgus load, ensure the knee remains at 20° of flexion.	A knee not kept at 20° flexion may not accurately demonstrate the slow release of the MCL and can risks excessive trephination.
Trephination should occur at proximal 1/3 of MCL near the femoral insertion due to better healing potential.	Suboptimal needle angulation may risk iatrogenic cartilage injury to the femoral condyle or persistent valgus instability.

MCL, medial collateral ligament.