Nonoperative and operative treatments of medial collateral ligament injuries lead to equally good results. Medial collateral ligament ruptures need not be treated operatively when the anterior cruciate ligament is reconstructed in the early phase.

This study compares MRI with examination under anaesthesia to surgical findings in evaluating soft tissue injuries in acute multi-ligament knee trauma. Preoperative MRI was done for 44 patients who underwent surgery for grade III ACL and grade III medial collateral ligament (MCL) injury. In 21 cases both ACL and MCL were treated surgically, but in 23 only ACL. Intra-operative and MRI findings were compared. Accuracy of MRI for medial meniscal tears was 88.6%, sensitivity 80%, and specificity 91.2%; accuracy for lateral meniscal tears was 72.7%, sensitivity 55% and specificity 87.5%. Accuracy and sensitivity for severity of ACL tear was 93.2% and of MCL tear 86.4%. In 88.6% of the knees, bone bruises were visible, with anterolateral femoral and posterolateral tibial bone bruise being the most common. MRI revealed no chondral lesion, but arthroscopy revealed 11. In combined ACL-MCL ruptures, the incidence of concomitant injuries is high and the injuries are best detected with MRI.

Early operative treatment of combined anterior cruciate and medial collateral ligament injuries is possible without increased long-term mobilization complications. The rehabilitation period is long, and aggressive physiotherapy is recommended. However, nonoperative treatment of the torn medial collateral ligament allows faster restoration of flexion and quadriceps muscle power. Our results favor nonoperative treatment of the torn medial collateral ligament in patients with combined injuries.

Purpose In knee dislocation with bicruciate ligament and medial side injury (KDIIIM), treatment method of medial side injuries is controversial. The purpose of this study was to evaluate the outcomes of non-operative treatment of proximal and midsubstance and operative treatment of distal avulsion medial collateral ligament (MCL) ruptures in patients with early bicruciate reconstruction. Methods One-hundred and forty-seven patients with a knee dislocation and bicruciate ligament injury (KDII-KDV) were identified. Sixty-two patients had KDIIIM injury. Of these, 24 patients were excluded and 13 were lost to follow-up. With a minimum of 2 years of follow-up, IKDC2000 (subjective and objective), Lysholm and Tegner scores and stress radiographs were recorded. Results Twenty-five patients were available for follow-up: 18 had a proximal or midsubstance grade-III MCL rupture (proximal MCL group) and 7 had a distal MCL avulsion (distal MCL group). In the proximal MCL and distal MCL groups, respectively, median IKDC2000 subjective scores were 80 (range 57-99) and 62 (range 39-87), and median Lysholm scores were 88 (range 57-99) and 75 (range 40-100). The median medial opening (side-to-side difference) was 2.4 mm (range 0.1-9.2) in the proximal MCL group and 2.5 mm (range 0.2-4.8) in the distal MCL group. Conclusion We found acceptable recorded outcomes in patients who underwent non-operative treatment of proximal and midsubstance grade-III MCL rupture and operative treatment of distal MCL avulsion with early bicruciate ligament reconstruction. Level of evidence Level IV

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