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Proximal ruptures have decreased residual valgus laxity following nonoperative treatment than distal ruptures
17%
869/5003
They result in greater than 10 mm of valgus opening
6%
280/5003
They can result in a Stener-type lesion
13%
634/5003
They require operative repair when there is a concomitant anterior cruciate ligament tear
50%
2479/5003
Proximal ruptures have better healing potential with nonoperative treatment than distal ruptures
14%
711/5003
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Grade III indicates a complete rupture of the MCL with greater than 10mm of opening on valgus stress. Careful evaluation is needed to evaluate for concomitant injuries such as medial meniscus and ACL tears. However, the presence of an ACL tear does not preclude nonoperative treatment. Timing of ACL reconstruction with a concomitant MCL sprain should be delayed proportional to the extent of MCL damage. (Grade I injuries, 3-4 weeks; grade II injuries, 4-6 weeks; grade III injuries, 6-8 weeks.) According to Shelbourne et al, many surgeons recommend nonoperative management of acute grade III MCL injuries occurring at the femoral origin or mid-substance, and primary repair of injuries at the tibial origin. Perhaps because of better vascularity, proximal tears tend to heal better than distal ones. In contrast, distal ruptures may heal with excessive valgus instability and occasionally result in a Stener-type lesion with the torn MCL flipped over the insertion of the pes anserinus where it is unable to heal normally. Illustration A is an MRI image showing a distal grade III rupture. The reference by Azar provides a review of the anatomy, clinical exam and treatment options for MCL tears.
3.8
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