Management of Acute Combined ACL-Medial and Posteromedial Instability of the Knee

Abstract

Medial collateral ligament (MCL) injuries are the most common ligamentous injury of the knee. The extent of injury can range from a minor first-degree (1-degree) sprain to an extensive third-degree (3-degree) sprain that can propagate across the knee, rupturing one or both cruciate ligaments, and result in a knee subluxation or dislocation. A common pattern involves the combined anterior cruciate ligament (ACL) and MCL injury that is the focus of this chapter. The vast majority of these combined medial-sided injuries are treated nonoperatively with delayed reconstruction of the ACL injury in athletically active individuals. The MCL and associated medial structures are carefully assessed on physical examination, and classification of injury is based upon abnormal limits of joint motion. In vitro cadaveric biomechanical testing has given us a better understanding of ligament deficiency and altered joint motion. Consistency in terminology is necessary for proper classification of injury and reproducible categorization of injury patterns to be able to compare both nonoperative and operative treatment of various injury patterns.

Treatment of medial-sided injuries in patients with early bicruciate ligament reconstruction for knee dislocation

“…Operative treatment is widely recommended for distal MCL avulsion injury in the presence of an MCL Stener-like lesion, and when the MCL is trapped in the joint [ 25 , 40 , 42 ]. The risk of residual valgus laxity after conservative treatment is high.…”

“…Good results have been reported with both non-operative and operative treatments of medial side injuries and bicruciate ligament reconstruction in the acute phase [ 3 , 7 , 22 , 34 , 38 ]. There is a risk of residual valgus laxity with conservative treatment of distal MCL avulsion injury [ 42 ] or in the presence of an MCL Stener-like lesion [ 5 , 40 ], and operative treatment is recommended for a grade-III distal tear or tibial avulsion of the MCL [ 2 , 25 , 26 ]. Repair of acute or chronic MCL rupture seems to carry a higher risk for poor outcome compared with reconstruction [ 19 , 32 ].…”

A Case-Control Study Comparing Bone Bruising and Intra-articular Injuries in Patients Undergoing Anterior Cruciate Ligament Reconstruction With and Without Medial Collateral Ligament Tears

“…We found that combined ACL-MCL injuries primarily resulted from contact injuries, which is consistent with previous literature. 13 ACL-MCL injuries are often caused by contact or collision during sports such as football, rugby, and soccer and result in valgus stress and combined tibial external rotation. 5 , 13 Paul et al 18 compared comorbid knee pathology in 263 patients undergoing ACL reconstruction for jumping versus nonjumping injuries.…”

“… 13 ACL-MCL injuries are often caused by contact or collision during sports such as football, rugby, and soccer and result in valgus stress and combined tibial external rotation. 5 , 13 Paul et al 18 compared comorbid knee pathology in 263 patients undergoing ACL reconstruction for jumping versus nonjumping injuries. The prevalence of MCL injuries was greater for nonjumping injuries (12%) versus jumping injuries (4.3%), and most of the nonjumping injuries involved a contact mechanism.…”

Concomitant Reconstruction of Anterior Cruciate Ligament and Medial Collateral Ligament Surgical procedure and clinical outcomes

“…Concomitant ACL-MCL injuries can be associated with important rotatory laxity, valgus and sagittal instability [4,5]. The therapeutic options of ACL and MCL injuries are either nonsurgical treatment of MCL and ACL reconstruction or simultaneous ACL-MCL reconstruction [6][7][8]. Some authors consider that MCL injuries can heal conservatively in 8-12 weeks and only in rare cases the reconstruction of both ligaments is necessary.…”