Anterior Cruciate Ligament Injury with MCL Injury

The medial collateral ligament (MCL) is the most common knee ligament to be injured during knee trauma. The annual incidence of MCL injury has been reported as 0.24–7.3 per 1000 people with a male to female ratio of 2:1. It is a common injury during soccer, skiing, as a result of either a direct valgus force to players’ knees or cutting maneuvers, when athletes fix one side foot and suddenly change their direction. MCL injury usually occur as an isolated injury; however, it may present in combination with other ligament injuries. Approximately 78% of patients with grade III MCL injury had an injury combined ligament damage, of which the most common are accompanied by anterior cruciate ligament injury. Incomplete tears (grade I, II) and isolated tears (grade III) of the MCL without valgus alignment knee can be treated conservatively, with early limited ROM (0–90 flexion) brace and quadriceps muscle strengthening exercise. Acute repair is indicated in isolated grade III tears with moderate to severe valgus alignment knee, MCL entrapment over pes anserinus, or intra-articular entrapment or bony avulsion. The indication for primary repair is based on the resulting quality of the original MCL ligament and the time since the injury. Primary repair of the MCL is usually performed within 7–10 days after the injury. Augmentation repair for the superficial MCL (sMCL) is a surgical technique that can be used when the original MCL ligament is not so good quality and primary repair impossible and also mid substance tear of the MCL. Reconstruction is indicated when MCL injuries fail to heal in neutral or varus alignment. Chronic, medial-sided knee injuries with valgus malalignment should be treated with a two-stage approach. A distal femoral osteotomy should be performed first, followed by reconstruction of the MCL, posteromedial corner(PMC), posterior oblique ligament(POL).