From the Guidelines
No, a ruptured Medial Collateral Ligament (MCL) is not typically considered a surgical condition.
Rationale
- The American Academy of Orthopaedic Surgeons clinical practice guideline summary states that non-surgical treatment of MCL injuries can result in good patient outcomes, even in cases of combined Anterior Cruciate Ligament (ACL) and MCL tears 1.
- The guideline suggests that surgical treatment of the MCL may be considered in select cases, but the strength of this recommendation is Limited, indicating that practitioners should exercise clinical judgment and consider patient preference when making treatment decisions 1.
- This implies that surgery is not the default treatment for a ruptured MCL, and that non-surgical management is a viable option for many patients.
- The guideline's emphasis on patient preference and clinical judgment suggests that treatment decisions should be made on a case-by-case basis, rather than following a one-size-fits-all approach.
From the Research
Ruptured Medial Collateral Ligament (MCL) Treatment
- A ruptured MCL is not always a surgical condition, as treatment options depend on the severity and location of the injury, as well as the presence of associated injuries 2, 3, 4.
- Non-operative treatment is often recommended for grade I and II MCL injuries, as well as some grade III injuries, especially if the injury is isolated and there are no other ligamentous injuries 3, 4.
- Surgical treatment may be necessary for grade III MCL injuries with associated injuries, such as anterior or posterior cruciate ligament injuries, or in cases of chronic medial knee instability 2, 3, 5.
- Primary repair of the MCL with internal bracing is a surgical technique that can be used to treat acute MCL injuries, allowing for early surgical intervention and rehabilitation 6.
- Refixation of the MCL and posteromedial complex can be performed in cases of severe acute medial instability, with good results reported in terms of improving medial instability 5.
Indications for Surgical Treatment
- Associated injuries, such as anterior or posterior cruciate ligament injuries 2, 3, 5.
- Chronic medial knee instability 3, 5.
- Grade III MCL injuries with dehiscence or dislocation of the ligament stumps 4.
- Ruptures close to the abutment and bony avulsions 4.
- Multiligamentous injuries or complex instability 2, 4.