Skip to main content
Erschienen in: Current Reviews in Musculoskeletal Medicine 2/2019

30.03.2019 | ACL: Risk Factors, Outcomes, Preventions (R Gallo, Section Editor)

Combined Anterior Cruciate Ligament and Medial Collateral Ligament Knee Injuries: Anatomy, Diagnosis, Management Recommendations, and Return to Sport

verfasst von: Joshua L. Elkin, Edgar Zamora, Robert A. Gallo

Erschienen in: Current Reviews in Musculoskeletal Medicine | Ausgabe 2/2019

Einloggen, um Zugang zu erhalten

Abstract

Purpose of review

The diagnosis and management of combined anterior cruciate ligament (ACL) and medial collateral ligament (MCL) injuries have been a controversial topic for several decades. No single approach has proven optimal for treatment and there is no consensus between most specialists. This review seeks to describe and clarify the current state and the future of management.

Recent findings

Most authors agree on reconstructing of the ACL with non-operative management of the MCL in grade I and II injuries, respectively. However, controversy still exists about the optimal method of treating a combined ACL with higher grade MCL injuries.

Summary

Management should be customized based on acuity, injury grade, and specific goals for each patient. Future research with clinical outcomes may facilitate creating guidelines to optimize recovery.
Literatur
1.
Zurück zum Zitat Bernstein J. Musculoskeletal medicine. Rosemont, Ill: Amer Academy of Orthopaedic; 2003. Bernstein J. Musculoskeletal medicine. Rosemont, Ill: Amer Academy of Orthopaedic; 2003.
5.
Zurück zum Zitat Grood ES, Noyes FR, Butler DL, Suntay WJ. Ligamentous and capsular restraints preventing straight medial and lateral laxity in intact human cadaver knees. J Bone Joint Surg Am. 1981;63:1257–69.CrossRefPubMed Grood ES, Noyes FR, Butler DL, Suntay WJ. Ligamentous and capsular restraints preventing straight medial and lateral laxity in intact human cadaver knees. J Bone Joint Surg Am. 1981;63:1257–69.CrossRefPubMed
7.
Zurück zum Zitat Phisitkul P, James SL, Wolf BR, Amendola A. MCL injuries of the knee: current concepts review. Iowa Orthop J. 2006;26:77–90.PubMedPubMedCentral Phisitkul P, James SL, Wolf BR, Amendola A. MCL injuries of the knee: current concepts review. Iowa Orthop J. 2006;26:77–90.PubMedPubMedCentral
8.
Zurück zum Zitat Hughston JC, Andrews JR, Cross MJ, Moschi A. Classification of knee ligament instabilities. Part I. The medial compartment and cruciate ligaments. J Bone Joint Surg Am. 1976;58:159–72.CrossRefPubMed Hughston JC, Andrews JR, Cross MJ, Moschi A. Classification of knee ligament instabilities. Part I. The medial compartment and cruciate ligaments. J Bone Joint Surg Am. 1976;58:159–72.CrossRefPubMed
9.
Zurück zum Zitat Mangine RE, Minning SJ, Eifert-Mangine M, Colosimo AJ, Donlin M. Management of the patient with an ACL/MCL injured knee. North Am J Sports Phys Ther. 2008;3:204–11. Mangine RE, Minning SJ, Eifert-Mangine M, Colosimo AJ, Donlin M. Management of the patient with an ACL/MCL injured knee. North Am J Sports Phys Ther. 2008;3:204–11.
11.
Zurück zum Zitat Fetto JF, Marshall JL. Medial collateral ligament injuries of the knee: a rationale for treatment. Clin Orthop. 1978:206–18. Fetto JF, Marshall JL. Medial collateral ligament injuries of the knee: a rationale for treatment. Clin Orthop. 1978:206–18.
15.
16.
Zurück zum Zitat Jokl P, Kaplan N, Stovell P, Keggi K. Non-operative treatment of severe injuries to the medial and anterior cruciate ligaments of the knee. J Bone Joint Surg Am. 1984;66:741–4.CrossRefPubMed Jokl P, Kaplan N, Stovell P, Keggi K. Non-operative treatment of severe injuries to the medial and anterior cruciate ligaments of the knee. J Bone Joint Surg Am. 1984;66:741–4.CrossRefPubMed
17.
Zurück zum Zitat Hughston JC. The importance of the posterior oblique ligament in repairs of acute tears of the medial ligaments in knees with and without an associated rupture of the anterior cruciate ligament. Results of long-term follow-up. J Bone Joint Surg Am. 1994;76:1328–44.CrossRefPubMed Hughston JC. The importance of the posterior oblique ligament in repairs of acute tears of the medial ligaments in knees with and without an associated rupture of the anterior cruciate ligament. Results of long-term follow-up. J Bone Joint Surg Am. 1994;76:1328–44.CrossRefPubMed
18.
Zurück zum Zitat Frölke JP, Oskam J, Vierhout PA. Primary reconstruction of the medial collateral ligament in combined injury of the medial collateral and anterior cruciate ligaments. Short-term results. Knee Surg Sports Traumatol Arthrosc. 1998;6:103–6. https://doi.org/10.1007/s001670050081. Frölke JP, Oskam J, Vierhout PA. Primary reconstruction of the medial collateral ligament in combined injury of the medial collateral and anterior cruciate ligaments. Short-term results. Knee Surg Sports Traumatol Arthrosc. 1998;6:103–6. https://​doi.​org/​10.​1007/​s001670050081.
22.
Zurück zum Zitat Hillard-Sembell D, Daniel DM, Stone ML, Dobson BE, Fithian DC. Combined injuries of the anterior cruciate and medial collateral ligaments of the knee. Effect of treatment on stability and function of the joint. J Bone Joint Surg Am. 1996;78:169–76.CrossRefPubMed Hillard-Sembell D, Daniel DM, Stone ML, Dobson BE, Fithian DC. Combined injuries of the anterior cruciate and medial collateral ligaments of the knee. Effect of treatment on stability and function of the joint. J Bone Joint Surg Am. 1996;78:169–76.CrossRefPubMed
25.
27.
Zurück zum Zitat Harner CD, Waltrip RL, Bennett CH, Francis KA, Cole B, Irrgang JJ. Surgical management of knee dislocations. J Bone Joint Surg Am. 2004;86-A:262–73.CrossRef Harner CD, Waltrip RL, Bennett CH, Francis KA, Cole B, Irrgang JJ. Surgical management of knee dislocations. J Bone Joint Surg Am. 2004;86-A:262–73.CrossRef
28.
Zurück zum Zitat Miyamoto RG, Bosco JA, Sherman OH. Treatment of medial collateral ligament injuries. J Am Acad Orthop Surg. 2009;17:152–61.CrossRefPubMed Miyamoto RG, Bosco JA, Sherman OH. Treatment of medial collateral ligament injuries. J Am Acad Orthop Surg. 2009;17:152–61.CrossRefPubMed
29.
Zurück zum Zitat Sandberg R, Balkfors B, Nilsson B, Westlin N. Operative versus non-operative treatment of recent injuries to the ligaments of the knee. A prospective randomized study. J Bone Joint Surg Am. 1987;69:1120–6.CrossRefPubMed Sandberg R, Balkfors B, Nilsson B, Westlin N. Operative versus non-operative treatment of recent injuries to the ligaments of the knee. A prospective randomized study. J Bone Joint Surg Am. 1987;69:1120–6.CrossRefPubMed
30.
Zurück zum Zitat •• Gallo RA, Kozlansky G, Bonazza N, Warren RF. Combined anterior cruciate ligament and medial collateral ligament reconstruction using a single Achilles tendon allograft. Arthrosc Tech. 2017;6:e1821–7. https://doi.org/10.1016/j.eats.2017.06.060 Gallo et al. investigated a novel approach in using one single allograft for ACL/high-grade MCL reconstructions, potentially reducing morbidity compared to multiple allografts or autografts.CrossRefPubMedPubMedCentral •• Gallo RA, Kozlansky G, Bonazza N, Warren RF. Combined anterior cruciate ligament and medial collateral ligament reconstruction using a single Achilles tendon allograft. Arthrosc Tech. 2017;6:e1821–7. https://​doi.​org/​10.​1016/​j.​eats.​2017.​06.​060 Gallo et al. investigated a novel approach in using one single allograft for ACL/high-grade MCL reconstructions, potentially reducing morbidity compared to multiple allografts or autografts.CrossRefPubMedPubMedCentral
31.
Zurück zum Zitat •• Hetsroni I, Mann G. Combined reconstruction of the medial collateral ligament and anterior cruciate ligament using ipsilateral quadriceps tendon-bone and bone-patellar tendon-bone autografts. Arthrosc Tech. 2016;5:e579–87. https://doi.org/10.1016/j.eats.2016.02.021 The use of the semitendinosus tendon in the past has largely limited anterior and medial integrity of an already weakened knee. Hetsroni et al. investigated and detailed a novel approach to using ipsilateral quadriceps to protect structural integrity as a potential future standard of care. CrossRefPubMedPubMedCentral •• Hetsroni I, Mann G. Combined reconstruction of the medial collateral ligament and anterior cruciate ligament using ipsilateral quadriceps tendon-bone and bone-patellar tendon-bone autografts. Arthrosc Tech. 2016;5:e579–87. https://​doi.​org/​10.​1016/​j.​eats.​2016.​02.​021 The use of the semitendinosus tendon in the past has largely limited anterior and medial integrity of an already weakened knee. Hetsroni et al. investigated and detailed a novel approach to using ipsilateral quadriceps to protect structural integrity as a potential future standard of care. CrossRefPubMedPubMedCentral
32.
Zurück zum Zitat Blanke F, Vonwehren L, Pagenstert G, Valderrabano V, Majewski M. Surgical technique for treatment of concomitant grade II MCL lesion in patients with ACL rupture. Acta Orthop Belg. 2015;81:442–6.PubMed Blanke F, Vonwehren L, Pagenstert G, Valderrabano V, Majewski M. Surgical technique for treatment of concomitant grade II MCL lesion in patients with ACL rupture. Acta Orthop Belg. 2015;81:442–6.PubMed
35.
Zurück zum Zitat Salter RB. The biologic concept of continuous passive motion of synovial joints. The first 18 years of basic research and its clinical application. Clin Orthop. 1989:12–25. Salter RB. The biologic concept of continuous passive motion of synovial joints. The first 18 years of basic research and its clinical application. Clin Orthop. 1989:12–25.
Metadaten
Titel
Combined Anterior Cruciate Ligament and Medial Collateral Ligament Knee Injuries: Anatomy, Diagnosis, Management Recommendations, and Return to Sport
verfasst von
Joshua L. Elkin
Edgar Zamora
Robert A. Gallo
Publikationsdatum
30.03.2019
Verlag
Springer US
Erschienen in
Current Reviews in Musculoskeletal Medicine / Ausgabe 2/2019
Elektronische ISSN: 1935-9748
DOI
https://doi.org/10.1007/s12178-019-09549-3

Weitere Artikel der Ausgabe 2/2019

Current Reviews in Musculoskeletal Medicine 2/2019 Zur Ausgabe

Injuries in Overhead Athletes (J Dines and C Camp, Section Editors)

On-field Management of Shoulder and Elbow Injuries in Baseball Athletes

Injuries in Overhead Athletes (J Dines and C Camp, Section Editors)

Hand and Wrist Injuries in Tennis Players

Outcomes Research in Orthopedics (O Ayeni, Section Editor)

Patient-Reported Outcome Measures for Patellofemoral Instability: a Critical Review

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen. 
» Jetzt entdecken

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.