Combined medial collateral and anterior cruciate ligament sprains increase the risk of lateral meniscal tears according to a new study.
This article summarises the key findings of: Epidemiology and Characteristics of Meniscal Tears in Patients With Combined ACL and Medial Collateral Ligament Injuries Versus Isolated ACL Tears: A Case-Control Study From the Francophone Arthroscopic Society. For the complete methodology, raw data, and statistical analyses, we strongly recommend consulting the full publication.
A combined anterior cruciate ligament (ACL) and MCL (medial collateral ligament) injury is more complex than an isolated ACL tear. A key clinical question: does this combination change the pattern of associated meniscal damage? Here is what the data shows.
Study at a Glance
This prospective, multicenter, case-control study was conducted across 10 hospitals in France as part of a symposium of the French Society of Arthroscopy. It compared patients undergoing ACL reconstruction with and without a concurrent MCL injury.
| Study Parameter | Value |
| Study type | Prospective, multicenter, case-control |
| Number of hospitals | 10 hospitals in France |
| Total patients included | 722 patients |
| Mean patient age | 30.32 ± 10.78 years |
| ACL + MCL group | 408 patients |
| Isolated ACL group | 314 patients |
| Matching criteria | Sex, age (± 3 years), BMI (± 3) |
| Chronicity threshold | Acute < 3 months / Chronic ≥ 3 months |
Surgeons systematically explored for three types of meniscal lesions:
- Ramp lesions: tears at the junction between the posterior medial meniscus and the joint capsule
- Root lesions: tears at the tibial attachment point of the meniscus
- Other lesion types including longitudinal tears
Key Results: 3 Important Numbers around ACL and MCL ligaments and Meniscal Tears
When ACL and MCL ligaments are injured simultaneously, the associated meniscal
damage is not only more frequent but also follows a different anatomical distribution, with a significantly higher rate of lateral meniscal tears and a distinct lesion-type
profile compared to isolated ACL tears.
1. Overall Meniscal Tear Frequency
Meniscal injuries were significantly more frequent in the combined ACL/MCL group:
| Group | Patients with meniscal tear | Percentage |
| Combined ACL + MCL injury | 217 / 408 | 53.2% |
| Isolated ACL tear | 130 / 314 | 41.4% |
| p-value | p = .001 | Statistically significant |
Clinical implication:More than 1 in 2 patients with a torn ACL and MCL also presents a meniscal tear requiring intraoperative treatment.
2. Lateral Meniscal Lesions: More Than Double the Rate
The most striking finding concerns the lateral meniscus (the cartilage pad on the outer side of the knee):
| Group | Lateral meniscal tear rate | |
| Combined ACL + MCL injury | 41.9% | ↑ more than double |
| Isolated ACL tear | 20.8% | |
| p-value | p < .001 | Highly significant |
This pattern was consistent regardless of injury chronicity (acute or chronic), suggesting that the addition of an MCL injury fundamentally alters the biomechanical stress on the lateral knee compartment.
Conversely, medial meniscal lesions were more frequent in the isolated ACL group, also independent of chronicity.
3. Different Types of Medial Meniscal Tears Between Groups
Beyond frequency, the type of medial lesion differed significantly:
| Medial lesion type | ACL + MCL group | Isolated ACL group |
| Longitudinal tears | 45.9% | — |
| Ramp lesions | 28.7% | 58.3% |
| p-value | p < .001 | p < .001 |
No significant difference was found in the distribution of lateral meniscal lesion types between the two groups.
Clinical implication:Surgeons managing combined MCL and ACL injuries (mcl and acl injury) must actively search for lateral meniscal tears and longitudinal medial tears, a different intraoperative checklist than for isolated ACL tears.
Conclusion & Findings About Combined MCL and ACL Sprains and the Risk of Meniscal Damage
This multicenter study of 722 patients confirms that combined ACL and MCL injuries carry a significantly higher burden of meniscal damage than isolated ACL tears, with a distinct and predictable shift toward lateral meniscal involvement (41.9% vs 20.8%, p < .001).
These findings have direct implications for preoperative planning and intraoperative exploration in all patients presenting with medial collateral and anterior cruciate ligament sprains.
Interested in the broader scientific evidence on ligament injuries, knee reconstruction and sports traumatology? Explore the otherinternational scientific publications by Professor Étienne Cavaignac.