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Related Experiment Videos

What is the terrible triad?

F A Barber1

  • 1Division of Orthopedic Surgery, University of Texas Southwestern Medical Center, Dallas.

Arthroscopy : the Journal of Arthroscopic & Related Surgery : Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association
|January 1, 1992
PubMed
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The "unhappy triad" of knee injury is not consistently found in patients with anterior cruciate ligament and medial collateral ligament tears. This study found lateral meniscus tears more common than medial meniscus tears in these combined injuries.

Area of Science:

  • Orthopedic Surgery
  • Sports Medicine
  • Knee Biomechanics

Background:

  • The "unhappy triad" describes a common knee injury involving the anterior cruciate ligament (ACL), medial collateral ligament (MCL), and medial meniscus.
  • Historical reports suggest a high incidence of this specific injury combination.
  • Recent literature questions the prevalence and diagnostic criteria of the "unhappy triad".

Purpose of the Study:

  • To re-evaluate the occurrence of the "unhappy triad" in acute knee injuries.
  • To determine the association between anterior cruciate ligament (ACL) and medial collateral ligament (MCL) tears with meniscal injuries.
  • To analyze arthroscopically confirmed injuries of second degree or worse to the ACL and MCL.

Main Methods:

  • Retrospective review of 52 knees with arthroscopically confirmed acute injuries (second degree or worse) to the ACL and MCL.

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  • Categorization of injuries based on ACL and MCL tear severity (second or third degree).
  • Analysis of associated medial and lateral meniscus tears in relation to ligamentous injuries.

    • Main Results:

    • The classic "unhappy triad" (ACL, MCL, and medial meniscus tear) was not found in this series.
    • Eighty percent of knees with third-degree ACL and third-degree MCL tears had associated lateral meniscus tears.
    • Lateral meniscus tears were more frequent than medial meniscus tears in combined ACL and MCL injuries; medial meniscus tears were not observed in isolation.

    Conclusions:

    • The combination of injuries historically defined as the "unhappy triad" is not consistently present in acute ACL and MCL tears.
    • Lateral meniscus pathology is a more common associated injury than medial meniscus pathology in significant ACL and MCL tears.
    • Clinical assessment and diagnostic imaging should consider the varied patterns of meniscal and ligamentous injury in the knee.