The treatment of the MCL continues to evolve. Historically, predictably good or excellent results were achieved with primary repair of the torn MCL and POL.5,9-13 In O'Donoghue's series14 from 1950, he strongly advocated suture repair immediately after injury. Furthermore, Hughston and Barrett15 supported immediate primary repair of MCL and posterior oblique tears. In their series, they emphasized anterior advancement of the POL in order to restore medial stability.

The nonoperative approach to management of complete tears of the MCL was first advocated by Ellsasser et al.16 Fetto and Marshall17 also reported excellent results following complete isolated MCL tears, irrespective of whether they were treated with an open or closed surgical technique. In 1983, the senior author published the results of a series of isolated MCL tears of the knee treated nonoperatively.18 He found no advantage to direct suture repair when compared with a nonoperative approach that involved a structured rehabilitation program. In a subsequent article, the senior author and colleagues19 showed that this conservative approach was successful, even for the highly competitive athlete who returned to contact sports. In 1993, Reider et al20 reported excellent results in 35 athletes who had undergone conservative management of MCL tears with functional rehabilitation and been monitored for more than 5 years.

In patients with combined MCL and ACL injuries, many authors favor nonoperative management of the MCL after reconstruction of the ACL. Shelbourne and Porter21 claim that excellent subjective and objective results can be achieved with proper reconstruction of the ACL and nonoperative management of the MCL, even in the elite athlete. In most cases of combined injuries, Noyes and Barber-Westin22 also favor nonoperative management of the MCL. They state that after reconstruction of the ACL, high-demand athletes with extensive medial joint space laxity may require operative repair of the medial structures.22

More recent work at other centers continues to support nonoperative management of concomitant ACL and MCL injuries. Millett et al23 showed patients with 19 combined ACL tears and minimum grade II MCL tears. These patients underwent early reconstruction of the ACL and nonoperative treatment of the MCL. Serial clinical examinations demonstrated good functional outcomes, range of motion, and strength. No patient experienced ACL graft failure or valgus instability or required subsequent surgery for chondral or meniscal damage at

2 years.

Was this article helpful?

0 0
Cure Tennis Elbow Without Surgery

Cure Tennis Elbow Without Surgery

Everything you wanted to know about. How To Cure Tennis Elbow. Are you an athlete who suffers from tennis elbow? Contrary to popular opinion, most people who suffer from tennis elbow do not even play tennis. They get this condition, which is a torn tendon in the elbow, from the strain of using the same motions with the arm, repeatedly. If you have tennis elbow, you understand how the pain can disrupt your day.

Get My Free Ebook

Post a comment