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Medial collateral ligament injuries of the knee: a rationale for treatment.

Isolated MCL I and MCL II lesions evidence good recovery of integrity and function under non-operative modes of treatment. Isolated MCL III lesions may also be treated by non-operative management, but with the expectation of a slightly less successful result. However, there is an 80% incidence of concomitant ligament injury with this grade of lesion. The prognosis following injury to the MCL is significantly influenced by the presence of concurrent compromise of other ligaments, particularly that of the anterior cruciate ligament. Resolution of knee instability and dysfunction following a mixed MCL injury of any grade severity is best accomplished through operative intervention. Therefore, it is the authors' opinion that isolated MCL III and all mixed MCL lesions are best managed with operative treatment. Because of the apparent influence compromise of other ligament structures have on the recovery of MCL function, an attempt must be made to repair all acutely injured structures at the time of surgery. The keystones of a satisfactory result are early and accurate diagnosis, prompt treatment, and when indicated, complete surgical repair.

Adolescent↗

Injuries of the anterior cruciate and medial collateral ligaments of the knee. A retrospective analysis of clinical records--part I.

The difficulty in diagnosing and subsequently treating lesions of the anterior cruciate ligament (ACL) is demonstrated in a review of 136 cases. Twenty-one patients noted a "pop" at the time of injury and each had a lesion of the ACL. The mechanism of injury may be helpful. The commonly seen valgus external rotation injury was noted in 60% of the cases but internal rotation with hyperextension and/or hyperflexion were also reported. The anterior drawer sign, if present, increases the accuracy to 92.1%. Failure of early cast treatment occurred if the ACL was torn but not in lesions confined to the MCL. Early meniscectomy in the cruciate deficient patient did not alleviate the need for further surgery in this group. At surgery the medial meniscus was torn in 93/124 ligament injuries but in addition 14 tears of the lateral meniscus were found. Wound complications were frequent with infection (4.8%) always being associated with hematoma formation (9.5%).

Adult↗