Surgical Treatment of Combined ACL and Medial-Sided Knee Injuries: Acute and Chronic
10.15 Conclusion
sMCL sprains are common knee injuries but less commonly seen in combination with ACL tear. Accurate diagnosis of both sMCL and POL injury is critical to determine the optimal treatment plan. Typically, this injury is able to be effectively treated with nonoperative management of the medial-sided sprain and delayed treatment of ACL disruption, but early evaluation
Semimembranosus
POL (graft)
sMCL (graft) Fig. 10.15 Anatomical
medial knee ligament reconstruction. From [ 30 ] . Reprinted with permission
Fig. 10.16 Left knee s/p ACL quadriceps tendon autograft and MCL allograft reconstruction
with MRI is important in the assessment of 3° sMCL sprains and associated POL injuries to rule out associated problematic injuries that may lead towards surgical intervention.
Our literature on the diagnosis and management of collateral ligament injuries is still lacking in the accurate communication in the type of ligament injuries that are being assessed (isolated sMCL versus combined sMCL and POL, degree versus grade injury), and this has led to disparity in the classi fi cation of types of injuries being evaluated, and therefore, comparative analysis of studies is limited by this discrepancy. However, recent literature has consolidated our knowledge of the anatomy of the medial aspect of the knee, supported the use of stress radiography for objective assessment of medial ligament injury as well as provided biomechanical support for a medial ligamentous reconstructive option. We hope an emphasis on consistency in our communica- tion of the diagnostic classi fi cation of knee injury patterns will lead to improved clinical studies on the optimal treatment of the variations on this type of knee ligament injury.
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DOI 10.1007/978-0-387-49289-6_11, © Springer Science+Business Media New York 2013