The ACL is the most commonly injured ligament in the knee. ACL tears are one of the most common sports injuries and post operative conditions we see in our Boulder Physical Therapy and Lafayette Physical Therapy clinics. This ligament can be injured during cutting, pivoting sports requiring high speed or high load movements across the knee joint. In more severe injuries, the inside ligament (MCL) can also be torn. The terrible triad is an unfortunate injury seen in sports where athletes have sustained a tear of the ACL, MCL, and their inner meniscus.
Isolated MCL injuries are less common and often do well without the need for surgical interventions. Conversely, when MCL injuries are combined with ACL tears the stability of the knee joint is significantly impacted. Researchers have reported athletes have a 6-7 times greater chance of returning to sport if they sustain an ACL tear vs. an ACL and MCL tear. A recent study highlighted the odds of a return to sport if the ACL is reconstructed without treatment of the concurrently torn MCL.
Svantesson and colleagues performed a case control, cohort study on the return to sport likelihood between athletes with knee ligament injuries (Sports Health. 2024). Authors reported on outcomes in a group of athletes who sustained a concurrent ACL and MCL injury who underwent ACL reconstruction vs. their peers who had an isolated ACL injury and underwent ACL reconstruction. They were looking to determine the impact of a torn MCL on these patients recoveries following ACL reconstruction. Authors reported only 10% of the athletes with ACL reconstruction and a MCL tear returned to their prior levels of sport compared to the group with an isolated ACL reconstruction. Interestingly, no differences were found between groups on clinical functional tests, lower extremity strength, or self reported amounts of strenuous activities.
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