title: Treatment of combined complete tears of the anterior cruciate and medial collateral ligaments.
abstract: OBJECTIVE
  To develop an evidence-based algorithm for the treatment of combined complete tears of the anterior cruciate ligament (ACL) and medial collateral ligament (MCL).
  
  
  METHODS
  We performed a systematic review using computerized keyword searches of Medline, Embase, CINAHL (Cumulative Index to Nursing and Allied Health Literature), ACP Journal Club, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews. Two reviewers independently performed searches and article reduction. Studies that reported stratified outcomes data after the treatment of combined complete tears of the ACL and MCL were included. Data on clinical measures of laxity, range of motion, and strength, as well as subjective outcome measures, were summarized.
  
  
  RESULTS
  Five different treatment approaches were reported. Outcomes were better if the ACL was reconstructed and reconstruction was delayed to allow a return of knee range of motion. In many cases, this delay may allow the MCL to heal. MCL repair or reconstruction may be required if valgus instability remains after an appropriate rehabilitation period.
  
  
  CONCLUSIONS
  ACL reconstruction should be performed in a subacute time frame once full motion has returned. Valgus instability should be assessed at that time and MCL repair or reconstruction performed in those patients with persistent valgus instability.
  
  
  METHODS
  Level IV, systematic review of Level I to IV studies.
authors: MedSport, Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan 48106, USA. johngran@med.umich.edu
authors: John A
authors: JA
authors: Grant
authors: Eric
authors: E
authors: Tannenbaum
authors: Bruce S
authors: BS
authors: Miller
authors: Asheesh
authors: A
authors: Bedi
mesh_terms: D016118:Anterior Cruciate Ligament / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007718:Knee Injuries / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D017888:Medial Collateral Ligament, Knee / Q000293:injuries / Q000601:surgery*; D009104:Multiple Trauma / Q000601:surgery*; D011182:Postoperative Care / Q000379:methods; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology*; D019651:Plastic Surgery Procedures / Q000379:methods* / Q000534:rehabilitation; D020127:Recovery of Function; D016896:Treatment Outcome