Q: Last week, my 18-year-old son was skiing and twisted his left knee. His binding did not release and he felt a pop. The physician at the clinic in France put my son’s knee in a brace and thought he had an ACL and MCL tear. We returned to Miami and got an MRI scan that does show an ACL tear and an MCL tear with an avulsion fracture. The orthopedic surgeon said my son must have surgery to fix both the ACL and MCL. After looking online, it appears that most MCL tears do not need surgery and can just be braced to heal. Does the surgeon’s recommendation to fix both ligaments sound right and should I get a second opinion? Also, does the surgery need to be done right away?
A: Skiing can result in serious knee injuries, particularly when the binding does not release. Complete tears of more than one ligament can result in significant instability. The ACL, which is important in pivoting activities, when completely torn can not heal. The MCL is an important stabilizer in side to side movement.
Most MCL tears can heal in a brace without surgery. However, your son likely has a complete MCL tear as evidenced by the bony avulsion fracture where the ligament originates. Due to the risk of the MCL not healing correctly, I agree with the orthopedic surgeon that the MCL should be fixed and the ACL should be reconstructed to restore knee stability. This is particularly true for someone as active and young as your son.
The MCL is much easier to fix if the surgeon operates within a few weeks post injury. If you are still have questions, then a second opinion is an option.