Preoperative measures in ACL-MCL injuries don’t improve outcomes, new study finds.
Combined injuries of the anterior cruciate ligament (ACL) and medial collateral ligament (MCL) are common in knee trauma. But do preoperative strategies such as bracing, weight-bearing restriction or surgical timing influence recovery? This is precisely what the study Impact of preoperative measures on postoperative results in combined anterior cruciate and medial collateral ligament injuries: an analysis from the registry of the francophone arthroscopic society set out to explore.
The research involved 408 patients treated across eight French surgical centres, with Professor Cavaignac contributing to the findings.
No link between preoperative strategy and recovery outcomes
This prospective, multicentre study followed patients undergoing ACL reconstruction in the presence of an MCL injury. Researchers assessed several preoperative factors (such as type of brace used, degree of permitted weight-bearing and time between injury and surgery) to determine whether they influenced long-term recovery.
Surprisingly, none of these factors significantly impacted key postoperative outcomes. Patients showed similar rates of ACL re-rupture (2%), contralateral ACL injury (1.5%) and reoperation (7.4%) regardless of their preoperative management strategy. Functional scores such as IKDC, SKV, ACL-RSI and Tegner were also unaffected by whether a brace was used or how much weight the patient bore on the leg before surgery.
MCL injury severity still plays a role
While overall preoperative management did not affect the outcomes, the severity of the MCL injury itself did have an influence. Patients with Grade II or III MCL lesions were more likely to be operated on earlier and had more limited weight-bearing permissions before surgery. They also reported lower functional scores postoperatively, suggesting that injury severity remains a key prognostic factor, independently of how the preoperative phase is managed.
Thus, even though modifying preoperative measures does not directly influence surgical outcomes, understanding the grade of MCL injury remains crucial for patient care and expectations.
Rethinking the role of braces and surgical delay
A common assumption in clinical practice is that delaying surgery until inflammation subsides, or using specific types of knee braces, might optimise the recovery pathway. However, this study refutes that. No significant correlation was found between surgical delay and better results. Similarly, the type of brace (hinged or non-hinged) did not influence long-term recovery.
These results support a more flexible and patient-centred approach: allowing full weight-bearing and early range of motion as tolerated, and tailoring bracing according to the patient’s pain and sense of instability rather than imposing a rigid protocol.
Conclusion: time to focus on functional recovery
This study suggests that rather than rigidly adhering to preoperative protocols, clinicians should focus on early mobilisation, restoring range of motion and patient comfort. While further research is needed to refine guidelines, this data reinforces the idea that surgical delay, bracing type and weight-bearing limitations may not significantly influence the outcome in combined ACL-MCL injuries.
For patients suffering from ACL or multiligament injuries, Professor Cavaignac’s expertise in knee surgery and sports traumatology ensures care that is both evidence-based and individually tailored.