Abstract
Combined injury of the anterior cruciate ligament (ACL) and medial collateral ligament
(MCL) remains among the most common knee injury patterns in orthopaedics. 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 6 weeks to allow for MCL healing, followed by delayed ACL reconstruction.
Although acute treatment of the MCL was common in the 1970s, postoperative stiffness
was frequently reported. Moreover, studies of such treatment failed to show 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 intra-articular damage. Acute simultaneous
surgical treatment of both ligaments has the potential to avoid these shortcomings.
This article will review the evolution of treatment of ACL-MCL injuries and explain
how it shifted toward the current treatment algorithm. We will (1) discuss why the
consensus shifted, (2) discuss the shortcomings of the current treatment plan, (3)
discuss the potential advantages of acute simultaneous treatment, and (4) present
an overview of the available literature.
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Article info
Publication history
Published online: July 07, 2022
Accepted:
June 20,
2022
Received in revised form:
June 20,
2022
Received:
May 31,
2022
Footnotes
The authors report the following potential conflicts of interest or sources of funding: G.S.D. receives grants and consulting fees from Arthrex, outside the submitted work. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
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© 2022 Published by Elsevier on behalf of the Arthroscopy Association of North America
