Pattern in Simultaneous Rupture of the Medial Collateral Ligament and Anterior Cruciate Ligament Assessed by Magnetic Resonance Imaging

Background: Determining the exact details of complex traumatic injuries such as knee ligament rupture will be a crucial point in planning the surgical approach, which is determined through accurate imaging techniques such as magnetic resonance imaging (MRI). We aimed to evaluate the pattern of medial collateral ligament (MCL) rupture in patients who presented with simultaneous rupture of the anterior cruciate ligament (ACL) and MCL. Methods: We evaluated knee MRI in 44 patients (25 women and 19 men, mean age: 38.6 ± 5.4 years) who suffered from clinically acute simultaneous ACL and MCL injuries. Meniscus status, MCL rupture patterns, and pivot bone bruise were analyzed. Results: Concerning ACL rupture, 38.6% had a partial ACL rupture, and 61.4% had a complete rupture. The meniscus ruptured in 61.4%. The most common site of the meniscus rupture was related to the medial posterior horn (37.0%). The vertical type rupture was the most common (37.0%), followed by the horizontal rupture (29.6%). MCL rupture was present in all patients with grade 2 rupture revealed in 52.3%. Regarding the location of MCL ligament rupture, the highest ratio was found in the femoral site (65.9%). Semimembranosus rupture was observed in 2.3%. Pivot bone bruise was positive in 34.1%. Medial patellofemoral ligament (MPFL) rupture was also revealed in 68.2%. There was a significant relationship between the grade of rupture in the MCL and the presence of pivot bone bruise (P < 0.001). Conclusion: Femoral detachment of MCL and posterior horn of medial meniscus (PHMM) are the most common sites of MCL injury and meniscus rupture in the context of ACL rupture. Besides, our results show a relevant influence of the extent of bone bruise on the grade of MCL rupture.