Treatment of Medial Collateral Ligament Injuries in the Setting of Anterior Cruciate Ligament Rupture

Abstract The medial collateral ligament (MCL) is a robust structure located on the medial aspect of the knee and can be divided into superficial and deep layers. MCL injury is commonly associated with anterior cruciate ligament rupture. Unaddressed MCL laxity dramatically increases the rate of anterior cruciate ligament reconstruction failure. Accurate valgus stress testing is crucial when evaluating the integrity of the MCL, as it helps guide management. Imaging investigations are important for determining the location of an MCL injury, assessing the degree of retraction, identifying the presence of a Stener lesion, or ligament incarceration within the joint space. In the acute setting, MCL reconstruction and repair along with anterior cruciate ligament reconstruction is recommended for elite athletes with MCL laxity or anteromedial rotatory instability. In non‐elite patients, persistent grade 2 or 3 laxity beyond 12 weeks should prompt combined anterior cruciate ligament reconstruction with MCL repair and reconstruction. In chronic cases, a varus producing osteotomy should be considered in the setting of valgus malalignment in addition to ligamentous reconstruction.