Treatment of Combined Complete Tears of the Anterior Cruciate and Medial Collateral Ligaments

Purpose: To develop an evidence-based algorithm for the treatment of combined complete tears of the anterior cruciate ligament (ACL) and medial collateral ligament (MCL). Methods: We performed a systematic review using computerized keyword searches of Medline, Embase, CINAHL (Cumulative Index to Nursing and Allied Health Literature), ACP Journal Club, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews. Two reviewers independently performed searches and article reduction. Studies that reported stratified outcomes data after the treatment of combined complete tears of the ACL and MCL were included. Data on clinical measures of laxity, range of motion, and strength, as well as subjective outcome measures, were summarized. Results: Five different treatment approaches were reported. Outcomes were better if the ACL was reconstructed and reconstruction was delayed to allow a return of knee range of motion. In many cases, this delay may allow the MCL to heal. MCL repair or reconstruction may be required if valgus instability remains after an appropriate rehabilitation period. Conclusions: ACL reconstruction should be performed in a subacute time frame once full motion has returned. Valgus instability should be assessed at that time and MCL repair or reconstruction performed in those patients with persistent valgus instability. Level of Evidence: Level IV, systematic review of Level I to IV studies.