Comparison of Isolated ACL and Combined ACL/MCL Injuries in Professional Soccer and Rugby Players: Return to Play and Career Longevity Outcomes

Background: Combined injury of the anterior cruciate ligament (ACL) and medial collateral ligament (MCL) is the most common combined knee ligament injury. However, there is only limited evidence, and no clear consensus, on the optimum management of these injuries. Purpose: To determine the return-to-play (RTP) rate and time, career longevity, and rerupture rates of elite soccer and rugby players after combined ACL+MCL injuries and to compare RTP rate, career longevity, and rerupture rates in players with ACL+MCL injury versus those who have isolated ACL injuries. Study Design: Case series; Level of evidence, 4. Methods: A consecutive series of professional soccer and rugby players who underwent primary ACL reconstruction (ACLR), with and without MCL injury, and treatment between 2015 and 2022 were retrospectively reviewed. Indications for MCL surgery were medial opening on valgus stress in full extension and/or grade II/III valgus laxity at 30°, positive dial test for anteromedial rotatory instability (AMRI), a positive Slocum test in external rotation, or a “Stener-like” lesion or intra-articular MCL incarceration. RTP was defined as first competitive match appearance. Data were extracted from clinical notes, contact with teams’ medical staff, and publicly available databases. Results: A total of 230 athletes (238 knees) were included; 97 (40.8%) had ACLR only, 97 (40.8%) had ACLR + nonoperative MCL management, and 44 (18.5%) had ACLR + MCL reconstruction. Of these, 135 (56.7%) were soccer and 103 (43.3%) were rugby players. Mean follow-up was 5.8 ± 2.4 years with a minimum of 3.4 years. Overall RTP rate was 95.4% (96.3% soccer, 94.2% rugby). This was similar in the ACLR-only group, ACLR + nonoperative MCL group, and ACLR + MCL reconstruction group ( P = .06). Mean RTP time was 12.0 ± 4.4 months; 11.8 months for ACLR only, 12.2 months for ACLR + nonoperative MCL, and 11.9 months for ACLR + MCL reconstruction ( P = .88). Overall, 2- and 5-year still-playing rates were 79.8% and 67.7%, respectively, with no difference between subgroups at 2 ( P = .55) or 5 years ( P = .53). Conclusion: RTP times and career longevity after ACLR with and without MCL injury in professional soccer and rugby players are similar.