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Treating Combined Anterior Cruciate Ligament and Medial Collateral Ligament Injuries Operatively in the Acute Setting is Potentially Advantageous

      ABSTRACT

      Combined injury of the anterior cruciate ligament (ACL) and medial collateral ligament (MCL) remains among the most common knee injury patterns in orthopedics. Optimal treatment of grade III MCL injuries is still debated, especially when combined with ACL injury. Most patients with these severe injuries are treated conservatively for at least six weeks to allow for MCL healing, followed by delayed ACL reconstruction (ACLR).
      Although acute treatment of the MCL was common in the 1970s, postoperative stiffness was frequently reported. Moreover, these studies failed to demonstrate clinical benefits of surgical over conservative treatment, and the MCL exhibited intrinsic healing capacity, leading to the consensus that all MCL injuries are treated conservatively.
      The current delayed treatment algorithm for ACL-MCL injuries has several disadvantages. First, MCL healing may be incomplete, resulting in residual valgus laxity that places the ACL graft at greater risk of failure. Second, delayed treatment lengthens the overall rehabilitation period, thereby prolonging the presence of atrophy and delaying return to preinjury activity levels. Third, the initial healing period leaves the knee unstable for longer and risks further intraarticular damage. Acute simultaneous surgical treatment of both ligaments has the potential to avoid these shortcomings.
      This article will review the evolution of treatment for ACL-MCL injuries and explain how it shifted towards the current treatment algorithm. First, we will discuss (I) why the consensus shifted, (II) the shortcomings of the current treatment plan, (III) the potential advantages of acute simultaneous treatment, and (IV) an overview of the available literature.

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