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J Knee Surg 2014; 27(05): 359-368
DOI: 10.1055/s-0034-1381961
Special Focus Section
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Anterior Cruciate Ligament and Medial Collateral Ligament Injuries

Matthew Bollier
1   Department of Orthopaedic Surgery, University of Iowa Sports Medicine, Iowa City, Iowa
,
Patrick A. Smith
2   Columbia Orthopaedic Group, Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
› Author Affiliations
Further Information

Publication History

23 April 2014

01 May 2014

Publication Date:
20 June 2014 (online)

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Abstract

The diagnosis and treatment of combined anterior cruciate ligament (ACL) and medial collateral ligament (MCL) injuries have evolved over the past 30 years. A detailed physical examination along with careful review of the magnetic resonance imaging and stress radiographs will guide decision making. Early ACL reconstruction and acute MCL repair are recommended when there is increased medial joint space opening with valgus stress in extension, a significant meniscotibial deep MCL injury (high-riding medial meniscus), or a displaced tibial-sided superficial MCL avulsion (stener lesion of the knee). Delayed ACL reconstruction to allow for MCL healing is advised when increased valgus laxity is present only at 30 degrees of flexion and not at 0 degree. However, at the time of ACL surgery, medial stability has to be re-assessed after the reconstruction is completed. In patients with neutral alignment in the chronic setting, graft reconstruction of both the ACL and MCL is recommended.

Keywords

medial collateral ligament - meniscotibial - posterior oblique ligament - valgus stress test
 

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