A 25-year-old football player twists his knee in a valgus-external rotation force. He develops acute haemarthrosis and a positive Lachman test (grade 2) with a firm end-point. MRI shows ACL disruption, medial meniscus tear, and MCL sprain (O'Donoghue's unhappy triad). What is the initial management priority?
- A Immediate combined ACL + MCL repair in same sitting
- B Aspiration of haemarthrosis, brace for MCL, and ACL reconstruction after acute inflammation resolves (6–8 weeks) ✓
- C Plaster of Paris cylinder cast for 6 weeks
- D Conservative management with physiotherapy alone; surgery only if instability persists
Correct answer: B. Aspiration of haemarthrosis, brace for MCL, and ACL reconstruction after acute inflammation resolves (6–8 weeks)
Explanation
Current evidence favours delayed ACL reconstruction (6–8 weeks after injury) over immediate surgery; operating through acute haemarthrosis increases arthrofibrosis risk. MCL grade II sprains heal conservatively with a hinged brace; MCL repair is not routinely added. During the waiting period, RICE, aspiration for comfort, and rehabilitation exercises are initiated. ACL reconstruction (patellar tendon or hamstring autograft) is then performed electively in this young active athlete for functional stability, as ACL does not heal spontaneously.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
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Written and medically reviewed by the StethoPrep medical team.