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Document Title: Shelbourne-AJSM-May92.shtml
Article Title: Anterior cruciate ligament-medial collateral ligament injury: Nonoperative management of medial collateral ligament tears with anterior cruciate ligament reconstruction: A preliminary report
Authors: K. Donald Shelbourne, MD, and David A. Porter, MD.
Publication: American Journal of Sports Medicine, Baltimore, Maryland
Date: May-June 1992
Volume 20, Number 3, pages 283-286
Keywords: ACL, MCL, combined ligament tearing, ACL-MCL, MCL-ACL, MCL self-healing, ACL reconstruction.
(Reference-denoting numbers appear in the same point size as the document text. As with all Knee Library documents, this article is provided in full-text form.)
Comments: A classic article on dealing with combined ACL-MCL tearing. (The MCL's ability to self-heal is unique amongst the four main ligaments of the knee. This self-healing capability is due to the fact that the MCL is surrounded by the joint capsule [retinaculum], which keeps the torn ends of the ligament aligned and in close proximity, thereby enabling useful scarring-over and often-satisfactory regainment of valgus-restraint function. Typically, for 1-2 months after an MCL injury, the knee is protected by a long-leg rehabilitative-type brace; this allows the MCL to scar over without becoming overlength.)
ABSTRACT We present the results of a series of patients who had nonoperative management of the medial collateral ligament with anterior cruciate ligament reconstruction. From February 1983 through December 1989, 84 of 90 consecutive patients were available for followup (minimum, 1 year; mean, 3.1 years) with a combined anterior cruciate ligament-medial collateral ligament injury (anterior cruciate ligament rupture and medial collateral ligament tear) received surgical management by the same physician. The last 68 of these 84 patients who met the inclusion criteria underwent patellar tendon graft for anterior cruciate ligament reconstruction, with concomitant nonoperative management of medial collateral ligament tears.
Follow-up evaluation consisted of physical examination for medial laxity, range of motion, and isokinetic and KT-1000 testing. Brace use and postoperative level of competition were also recorded. In addition, the patients completed a subjective assessment questionnaire rating pain, swelling, and stability. They also rated overall activity level, and any changes in their ability to do the activities tested: walk, climb stairs, run, jump, or twist. Our results indicate that proper reconstruction of the anterior cruciate ligament, in conjunction with nonoperative management of tears of the medial collateral ligament in combined anterior cruciate ligament-medial collateral ligament injuries, can give excellent stability and good to excellent functional outcome in patients with combined anterior cruciate ligament-medial collateral ligament injuries.
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