Combined injuries of the medial collateral ligament and the anterior cruciate ligament - Early ACL reconstruction versus late ACL reconstruction

Aim of this retrospective study is to evaluate the effect of acute and late anterior cruciate ligament (ACL) reconstruction in patients with a combine d injury of the ACL and the medial collateral ligament (MCL). All MCL injur ies were treated non-operatively. In 27 patients (group I) we performed ear ly ACL reconstruction (within the first 3 weeks after injury). The postoper ative rehabilitation protocol included brace treatment for all patients ove r a period of 6 weeks. In 37 patients we performed late ACL reconstruction (after a minimum of 10 weeks). In this group initial non-operative MCL trea tment (6 weeks brace treatment) was followed by a period of accelerated reh abilitation. Patients with late ACL reconstruction had a lower rate of loss of motion after finishing the postoperative rehabilitation programme and a lower rate of re-arthroscopies for a loss of extension (group I: 4 patient s, group II: 1 patient). The difference in the mean quadriceps muscle stren gth (group I: 83.3%, group II: 86.3%) was not statistically significant. Af ter a mean interval of 22 months, we saw no difference in the frequency of anterior or medial instabilities or in the loss of motion. The Lysholm scor e was significantly better in the group with late ACL reconstruction (group I: 85.3, group II: 89.9). The position on the Tegner activity scale decrea sed in both groups, to 5.5 in group I (preoperatively: 6.0) and to 5.6 in g roup II (preoperatively: 5.9). With regard to the lower rate of motion comp lications in the early postoperative period, the lower rate of re-arthrosco pies, and the significantly better results in the Lysholm score, we prefer late ACL reconstruction in the treatment of combined injuries of the ACL an d the MCL.