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. 2024 Aug;40(8):2322-2336.
doi: 10.1016/j.arthro.2024.01.009. Epub 2024 Jan 17.

Early Anterior Cruciate Ligament Treatment Might Be Crucial for Acute Combined Anterior Cruciate Ligament and Medial Collateral Ligament Injuries: A Systematic Review of the Various Treatment Strategies

Jelle P van der List  1 , Rachel K Muscott  2 , Nihir Parikh  2 , Brian R Waterman  2 , Nicholas A Trasolini  2
Affiliations

Early Anterior Cruciate Ligament Treatment Might Be Crucial for Acute Combined Anterior Cruciate Ligament and Medial Collateral Ligament Injuries: A Systematic Review of the Various Treatment Strategies

Jelle P van der List et al. Arthroscopy. 2024 Aug.

Abstract

Purpose: To assess the outcomes of acute, combined, complete anterior cruciate ligament (ACL) and medial collateral ligament (MCL) injuries in the literature.

Methods: A literature search using PubMed, Embase, Scopus, and Cochrane Reviews was performed following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. The inclusion criteria were studies reporting outcomes of complete ACL-MCL injuries at a minimum of 12 months' follow-up. Data were presented as ranges.

Results: Twenty-seven studies with 821 patients were included (mean age, 29 years; 61% male patients; mean follow-up period, 27 months). There were 4 randomized trials, 10 Level III studies, and 13 Level IV studies. Nine different strategies were noted, of which nonoperative MCL treatment with acute ACL reconstruction and acute MCL repair with acute ACL reconstruction were most commonly performed. Nonoperative MCL-ACL treatment and acute MCL repair with nonoperative ACL treatment led to low rates of valgus stability at 30° of flexion (27%-68% and 36%-77%, respectively) compared with acute ACL reconstruction with either nonoperative MCL treatment (80%-100%), acute MCL repair (65%-100%), or acute MCL reconstruction (81%-100%). Lysholm scores were not different between the strategies.

Conclusions: Outcomes in this systematic review suggest that ACL stabilization in the acute setting might result in the lowest rates of residual valgus laxity, whereas there is no clear difference between the different MCL treatments along with acute ACL reconstruction. Nonoperative MCL treatment with either nonoperative or delayed ACL reconstruction, as well as acute MCL repair with either nonoperative or delayed ACL reconstruction, leads to higher rates of valgus laxity.

Level of evidence: Level IV, systematic review of Level I to IV studies.

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Conflict of interest statement

Disclosures The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: B.R.W. receives funding grants from Arthrex and Smith & Nephew; receives speaking and lecture fees from Arthrex and DePuy Mitek; is a board member of Vivorte, Kaliber AI, Spartan Bioscience, Arthroscopy, and Vericel; owns equity or stocks in Vivorte, Kaliber AI, and Spartan Bioscience; and reports a consulting or advisory relationship with FH ORTHO Group. All other authors J.P.v.d.L., R.K.M., N.P., and N.A.T. declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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