Therefore, the purpose of the present study was to evaluate the radiological and clinical outcomes after ACL-R with concomitant MCL repair or non-operative MCL treatment. However, results of functional US examinations for radiographic assessment following ACL-R and concomitant operative or non-operative treatment of the MCL are missing. Recently, mean values of medial joint space width in unloaded and standardized loaded conditions using a fixation device in healthy knees have been published. Functional ultrasound (US) examination can be used as a diagnostic tool to enhance postoperative radiological outcome measurement. Quantification of medial instability is commonly reported by clinical outcome, but radiological assessment is often missing. Therefore, postoperative MCL stability remains an important goal in the combined treatment of ACL and MCL injuries. From a biomechanical point of view, there is growing evidence that MCL deficiency is a risk factor for ACL graft failure. Time of surgery, surgical techniques (repair or reconstruction), and indication as well as strategy of non-operative treatment are controversially discussed. Whereas anatomic reconstruction of the ACL (ACL-R) using an autologous tendon graft represents the current gold standard, treatment strategies for MCL injuries remain inconsistent.

Level of evidenceДЄnterior cruciate ligament (ACL) injuries are in up to 35% of cases combined with lesions to the medial side of the knee and available evidence of treatment concepts for combined lesions is limited. However, grade II and III MCL lesions with subsequent operative MCL repair (group 1) result in slightly poorer subjective outcome scores. ConclusionДЄ differentiated treatment concept in combined ACL and MCL injuries based on injury patterns leads to reliable postoperative ligamentous knee stability in US-based and clinical examinations. No significant differences could be found for subjective IKDC or Tegner activity scores among the two groups. MCL repair resulted in lower Lysholm scores (75вЂ‰В±вЂ‰19 versus 86вЂ‰В±вЂ‰15 pвЂ‰<вЂ‰0.05). Side-to-side differences in US examinations were 0.4вЂ‰В±вЂ‰1.5В mm (mm) in 0В° and 0.4вЂ‰В±вЂ‰1.5В mm in 30В° knee flexion in group 1, and 0.9вЂ‰В±вЂ‰1.1В mm in 0В° and 0.5вЂ‰В±вЂ‰1.4В mm in 30В° knee flexion in group 2, with no statistically significant differences between both groups.

Group 2 showed a mean age of 33вЂ‰В±вЂ‰8В years (20% female) with a mean follow-up of 34вЂ‰В±вЂ‰15В months. Mean age of group 1 was 40вЂ‰В±вЂ‰12В years (60% female) with a mean follow-up of 33вЂ‰В±вЂ‰17В months. ResultsДЄ total of 40 patients (20 per group) met inclusion criteria. Clinical examination was performed and patient-reported outcomes were assessed by the use of the subjective knee form (IKDC), Lysholm score, and the Tegner activity scale. Medial knee joint width was determined in a supine position at 0В° and 30В° of knee flexion in unloaded and standardized loaded (=вЂ‰15 Dekanewton) conditions using a fixation device. Radiological outcome was assessed with functional US examinations. Grade II MCL injuries with dislocated tibial or femoral avulsions and grade III MCL ruptures underwent ligament repair whereas grade II injuries without dislocated avulsions were treated non-operatively. Patients agedвЂ‰>вЂ‰18В years undergoing primary ACL reconstruction with concomitant operative (group 1) or non-operative treatment of the MCL (group 2) between 20 were included after a minimum follow-up of 12В months. The aim of this study was to evaluate treatment outcome of combined acute ACL and MCL lesions using functional US and clinical examination. Anterior cruciate ligament (ACL) injuries are often combined with lesions of the medial collateral ligament (MCL).

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