Combined MCL
There is limited evidence in patients with acute ACL tear and MCL tear to support that the practitioner might perform reconstruction of the ACL and non-operative treatment of the MCL tear.

Rationale
Two low strength studies evaluated isolated reconstruction of the ACL in acute ACL/MCL and chronic ACL/MCL injuries in which the MCL injury was high grade, but not complete (no or minimal valgus laxity when tested in full extension).43, 75 Both used hinged braces in the post-operative period.  Their results for ACL laxity and function are comparable to ACL reconstruction in isolated ACL tears. Valgus laxity was reduced from pre-operative status, but still present. This did not seem to alter functional status.
 
Potential Benefits of Implementation
Potential benefits include reduction of surgery with decreased OR time and less likelihood of motion limitations.

Potential Harms of Implementation
Potential harms may include the late loss of function or recurrent ACL injury from the residual valgus laxity.

Future Research
Long term follow-up studies of ACL reconstructed patients with partial MCL tears treated non-operatively at the time of ACL reconstruction, compared to isolated ACL injuries treated with ACL reconstruction would establish if there is potential harm associated with this strategy of treatment for complete ACL tears with associated partial MCL tears.
 

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