BACKGROUND: Combined injuries of the anterior cruciate ligament (ACL) and medial collateral ligament (MCL) are frequent in knee trauma. Treatment approaches vary widely, including surgical and conservative methods. However, the impact of preoperative measures on postoperative outcomes remains unclear. HYPOTHESIS: Preoperative measures influence on postoperative outcomes for cases involving combined anterior cruciate and medial collateral ligament injuries. PATIENTS AND METHODS: A prospective, multicenter study was conducted in 8 French surgical centers specializing in knee surgery. Data were collected on patients undergoing ACL reconstruction with concomitant MCL injury over a 12-month period. Inclusion criteria were primary ACL injury associated with MCL injury (Grade I, II or III) and requiring ACL reconstruction, patients aged ≥ 15 years. The use and type of preoperative brace, weight-bearing and the time between injury and surgery were assessed. A functional assessment of the IKDC, ACL-RSI, TEGNER and SKV scores was performed at final follow-up. Patients were evaluated with regards of iterative ACL rupture, contralateral ACL rupture and reoperation. RESULTS: The study included 408 patients with a mean follow-up of 18.5 months. Time between injury and surgery did not significantly affect the risk of iterative rupture, contralateral rupture, or reoperation. No significant impact of preoperative brace type or weight-bearing status on postoperative outcomes was observed. However, patients with higher grade MCL injuries underwent surgery earlier (p <
0.0001) and had lower preoperative weight-bearing allowances (p <
0.05). Patients with Grade 2-3 MCL injuries had lower functional scores compared to those with Grade 1 injuries (p <
0.05). DISCUSSION: Preoperative measures, including time between injury and surgery, showed no significant influence on postoperative outcomes in combined ACL-MCL injuries. The type of preoperative brace and weight-bearing status did not significantly impact postoperative results. A functional approach with immediate full weight-bearing/recovery of full range of motion and with the use of bracing according to pain and patient apprehension is recommended. Further research is needed to refine preoperative treatment strategies for such injuries. LEVEL OF EVIDENCE: IV
prospective study.