Management of combined ACL-MCL tears: a systematic review

INTRODUCTION: The optimal management for combined anterior cruciate ligament-medial collateral ligament (ACL-MCL) injuries is controversial. SOURCES OF DATA: We performed a literature search using Medline, Cochrane and Google Scholar using the keywords: 'ACL' and 'MCL' in combination with 'surgery treatment', 'conservative treatment', 'surgery management', 'conservative management', 'surgical treatment' and 'surgical management'. We identified 23 published studies. AREAS OF AGREEMENT: Conservative and surgical management for combined ACL-MCL injuries resulted in different functional outcomes. The Coleman Methodology Score showed great heterogeneity in terms of study design, patient characteristics, management methods and outcome assessment and generally low methodological quality. AREAS OF CONTROVERSY: Given the heterogeneity in terms of treatment and results, we did not find a univocal trend over the years regarding MCL management (conservative or surgical). The use of several scoring systems did not allow us to compare outcomes in the different studies. GROWING POINTS: There is a need for a common validated scale for clinical measurements for ACL-MCL injuries, so as to allow easier and more reliable comparison of outcomes in different studies. To improve diagnostic certainty of combined ACL-MCL injuries, all patients should have imaging assessment (MR and stress-radiography) in addition to clinical examination. AREAS TIMELY FOR DEVELOPING RESEARCH: There is a need to perform appropriately powered randomized clinical trials of conservative and surgical treatment of combined ACL-MCL injuries, using standard diagnostic assessment, common and validated scoring system comparing reported outcomes and duration of follow-up more than 2 years.