Medial collateral ligament "tibial" injuries: indication for acute repair.

The medial collateral ligament (MCL) is the most commonly injured knee ligament.1-3 The mechanism of injury is typically a contact valgus load on the lateral side of the knee with the foot planted; however, noncontact external rotation valgus injuries are also common. Medial collateral ligament failure can occur alone or in combination with cruciate and meniscal injury. Fetto and Marshall4 found concomitant knee injury in 80% of grade III MCL injuries. The most common combined injury is anterior cruciate ligament (ACL) rupture followed by meniscal tear, and these must be ruled out when a patient presents with a complete MCL injury. TREATMENT Treatment for isolated complete MCL injury historically was surgical with acute repair of the medial structures including the superficial MCL, the capsular or deep ligament, and the posterior oblique ligament.5-9 O’Donoghue5,6 and Hughston7,8 reported their case series including combined injuries that did well with surgical repair of the medial structures when complete grade III MCL injury was present. Over the past three decades, many authors have reported equally successful results with conservative treatment of complete MCL injuries, which has now become the most common current standard of care for isolated lesions.4,10-16 Few reports of treatment have identified the injury site of the medial structures and how this affects healing and prognosis of the injured MCL. O’Donoghue5 demonstrated distal failure of the superficial MCL in most cases with proximal or mid-substance failure of the deeper capsular ligaments. Ellsasser et al10 showed by clinical examination 50 o f From the Division of Orthopedic Surgery, University of Kentucky, Lexington, Ky. Reprint requests: Timothy C. Wilson, MD, 740 S Limestone St, K401 Kentucky Clinic, Lexington, KY 40536. Complete avulsions of the superficial and deep medial collateral ligament from the tibia with disruption of the meniscal coronary ligament should be managed with acute surgical repair for maximum benefit. Medial Collateral Ligament “Tibial” Injuries: Indication for Acute Repair