Treatment of MCL injury in combined ACL/MCL injury

Abstract

Combined ACL and MCL injuries are the most common combined ligament injuries of the knee. Traditional management of isolated MCL injuries has been conservative. However, grade III MCL injuries or those associated with the PMC can lead to rotational laxity that can significantly impact patient functionality. Biomechanically AMRI associated with grade III MCL injuries puts increase stress on ACL grafts reconstructed in isolation, leading to higher chances of failure. This chapter aims to review which circumstances require MCL surgery and considers the evidence available to help us make this decision. Acute repair of MCL injuries in the context of combined ACL and MCL injuries is limited to MCL distal avulsions that lead to the “Stener-like” lesion. Otherwise adopting a “wait and see” approach seems to be a reasonable option where persistent MCL laxity can be addressed with MCL reconstruction at the time of ACL reconstruction. No one singular method for MCL reconstruction has proven superiority. Anatomical and nonanatomic reconstructions and tendon transfers using both autograft and allograft have been described.