Surgical Treatment of Combined ACL and Medial-Sided Knee Injuries: Acute and Chronic

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°) sprain to an extensive third-degree (3°) sprain that can propagate across the knee, rupturing both cruciate ligaments and result in a complete knee 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 exam, 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 in order to be able to compare both nonoperative and operative treatment of various injury patterns. Recently validated in vitro studies allow for the first biomechanically justified medial ligamentous reconstructive technique.