This retrospective study reviewed arthroscopic findings in 60 athletes with acute combined ACL-MCL injuries. It asked whether the classic O'Donoghue triad (ACL, MCL, medial meniscus) actually occurs as often as its fame suggests. Patients were split by MCL grade: second-degree versus third-degree tears.
When you evaluate an athlete with a combined ACL-MCL injury, expect the lateral meniscus to be the vulnerable structure, not the medial. The famous O'Donoghue triad is largely a historical artifact from the arthrotomy era. Arthroscopy reveals lateral meniscus tears outnumber medial tears roughly 2:1 in acute ACL knees.
MCL grade drives your intraarticular suspicion. A second-degree (partial) MCL tear correlates with more lateral meniscus and lateral chondral damage. A third-degree (complete) MCL tear paradoxically protects the joint: 60% of these knees had no meniscal or chondral injury, because the fully torn ligament dissipates the valgus energy.
Grade the MCL properly with a valgus stress test at 30 degrees flexion: 5 to 10 mm opening is second-degree, greater than 10 mm with no endpoint is third-degree.
This retrospective study reviewed arthroscopic findings in 60 athletes with acute combined ACL-MCL injuries. It asked whether the classic O'Donoghue triad (ACL, MCL, medial meniscus) actually occurs as often as its fame suggests. Patients were split by MCL grade: second-degree versus third-degree tears.
When you evaluate an athlete with a combined ACL-MCL injury, expect the lateral meniscus to be the vulnerable structure, not the medial. The famous O'Donoghue triad is largely a historical artifact from the arthrotomy era. Arthroscopy reveals lateral meniscus tears outnumber medial tears roughly 2:1 in acute ACL knees.
MCL grade drives your intraarticular suspicion. A second-degree (partial) MCL tear correlates with more lateral meniscus and lateral chondral damage. A third-degree (complete) MCL tear paradoxically protects the joint: 60% of these knees had no meniscal or chondral injury, because the fully torn ligament dissipates the valgus energy.
Grade the MCL properly with a valgus stress test at 30 degrees flexion: 5 to 10 mm opening is second-degree, greater than 10 mm with no endpoint is third-degree.