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Surgical Treatment of Acute Grade III Medial Collateral Ligament Injury Combined With Anterior Cruciate Ligament Injury: Anatomic Ligament Repair Versus Triangular Ligament Reconstruction.
Arthroscopy. 2015 Jun; 31(6):1108-16.A

Abstract

PURPOSE

The purpose of this study was to evaluate the clinical results of medial collateral ligament (MCL) anatomic ligament repair (ALR) and triangular ligament reconstruction (TLR) in treating acute grade III MCL injury with respect to imaging and functional results.

METHODS

Between January 2009 and October 2011, a total of 69 patients with an acute grade III MCL tear combined with an anterior cruciate ligament tear were divided into 2 groups: those who underwent ALR and those who underwent TLR. Single-bundle anterior cruciate ligament reconstruction was also performed in all patients. A radiographic stress-position imaging test was performed to evaluate excessive medial opening of the knee. In addition, the Slocum test was carried out to assess anteromedial rotatory instability before surgery and at follow-up. The subjective symptoms and functional outcomes were evaluated preoperatively and postoperatively with International Knee Documentation Committee (IKDC) assessment.

RESULTS

Sixty-four patients with a mean follow-up period of 34 months were included in the final analysis. The measurement results for medial opening at the last follow-up appointment decreased significantly from the pretreatment measurements and fell within the normal range, without a statistically significant difference between the 2 groups (P > .05). The overall incidence of anteromedial rotatory instability was reduced to 21.9% compared with 62.5% preoperatively. However, the incidence of anteromedial rotatory instability in the TLR group (9.4%) decreased significantly compared with that in the ALR group (34.4%) (P < .05). All patients' IKDC subjective scores significantly improved after surgery. No statistically significant difference was found between the 2 groups at the last follow-up (P > .05). The comparison of IKDC extension and flexion deficit scores between the 2 groups showed no significant differences. Eleven patients in the ALR group and 4 in the TLR group complained of medial knee pain. The comparison between the 2 groups showed no significant difference (P > .05).

CONCLUSIONS

The clinical outcomes of this study showed that no major difference existed in the ALR and TLR groups based on IKDC scores and medial opening evaluations in the short-term. However, TLR offered better rotatory stability than ALR at final follow-up.

LEVEL OF EVIDENCE

Level II, lesser-quality randomized controlled trial.

Authors+Show Affiliations

Department of Orthopaedic Center, Third Hospital, Hebei Medical University, Shijiazhuang, China.Department of Orthopaedic Center, Third Hospital, Hebei Medical University, Shijiazhuang, China.Department of Orthopaedic Center, Third Hospital, Hebei Medical University, Shijiazhuang, China.Department of Orthopaedic Center, Third Hospital, Hebei Medical University, Shijiazhuang, China.Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A.Department of Orthopaedic Center, Third Hospital, Hebei Medical University, Shijiazhuang, China.Department of Orthopaedic Center, Third Hospital, Hebei Medical University, Shijiazhuang, China.Department of Orthopaedic Center, Third Hospital, Hebei Medical University, Shijiazhuang, China.Department of Orthopaedic Center, Third Hospital, Hebei Medical University, Shijiazhuang, China.Department of Orthopaedic Center, Third Hospital, Hebei Medical University, Shijiazhuang, China.Department of Orthopaedic Center, Third Hospital, Hebei Medical University, Shijiazhuang, China. Electronic address: djtloveyz@outlook.com.

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

25753825

Citation

Dong, Jiangtao, et al. "Surgical Treatment of Acute Grade III Medial Collateral Ligament Injury Combined With Anterior Cruciate Ligament Injury: Anatomic Ligament Repair Versus Triangular Ligament Reconstruction." Arthroscopy : the Journal of Arthroscopic & Related Surgery : Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association, vol. 31, no. 6, 2015, pp. 1108-16.
Dong J, Wang XF, Men X, et al. Surgical Treatment of Acute Grade III Medial Collateral Ligament Injury Combined With Anterior Cruciate Ligament Injury: Anatomic Ligament Repair Versus Triangular Ligament Reconstruction. Arthroscopy. 2015;31(6):1108-16.
Dong, J., Wang, X. F., Men, X., Zhu, J., Walker, G. N., Zheng, X. Z., Gao, J. B., Chen, B., Wang, F., Zhang, Y., & Gao, S. J. (2015). Surgical Treatment of Acute Grade III Medial Collateral Ligament Injury Combined With Anterior Cruciate Ligament Injury: Anatomic Ligament Repair Versus Triangular Ligament Reconstruction. Arthroscopy : the Journal of Arthroscopic & Related Surgery : Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association, 31(6), 1108-16. https://doi.org/10.1016/j.arthro.2014.12.010
Dong J, et al. Surgical Treatment of Acute Grade III Medial Collateral Ligament Injury Combined With Anterior Cruciate Ligament Injury: Anatomic Ligament Repair Versus Triangular Ligament Reconstruction. Arthroscopy. 2015;31(6):1108-16. PubMed PMID: 25753825.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Surgical Treatment of Acute Grade III Medial Collateral Ligament Injury Combined With Anterior Cruciate Ligament Injury: Anatomic Ligament Repair Versus Triangular Ligament Reconstruction. AU - Dong,Jiangtao, AU - Wang,Xiao Feng, AU - Men,Xiaoqian, AU - Zhu,Junjun, AU - Walker,Garth N, AU - Zheng,Xiao Zuo, AU - Gao,Jin Bao, AU - Chen,Baicheng, AU - Wang,Fei, AU - Zhang,Yingze, AU - Gao,Shi Jun, Y1 - 2015/03/06/ PY - 2014/03/31/received PY - 2014/12/02/revised PY - 2014/12/04/accepted PY - 2015/3/11/entrez PY - 2015/3/11/pubmed PY - 2016/1/5/medline SP - 1108 EP - 16 JF - Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association JO - Arthroscopy VL - 31 IS - 6 N2 - PURPOSE: The purpose of this study was to evaluate the clinical results of medial collateral ligament (MCL) anatomic ligament repair (ALR) and triangular ligament reconstruction (TLR) in treating acute grade III MCL injury with respect to imaging and functional results. METHODS: Between January 2009 and October 2011, a total of 69 patients with an acute grade III MCL tear combined with an anterior cruciate ligament tear were divided into 2 groups: those who underwent ALR and those who underwent TLR. Single-bundle anterior cruciate ligament reconstruction was also performed in all patients. A radiographic stress-position imaging test was performed to evaluate excessive medial opening of the knee. In addition, the Slocum test was carried out to assess anteromedial rotatory instability before surgery and at follow-up. The subjective symptoms and functional outcomes were evaluated preoperatively and postoperatively with International Knee Documentation Committee (IKDC) assessment. RESULTS: Sixty-four patients with a mean follow-up period of 34 months were included in the final analysis. The measurement results for medial opening at the last follow-up appointment decreased significantly from the pretreatment measurements and fell within the normal range, without a statistically significant difference between the 2 groups (P > .05). The overall incidence of anteromedial rotatory instability was reduced to 21.9% compared with 62.5% preoperatively. However, the incidence of anteromedial rotatory instability in the TLR group (9.4%) decreased significantly compared with that in the ALR group (34.4%) (P < .05). All patients' IKDC subjective scores significantly improved after surgery. No statistically significant difference was found between the 2 groups at the last follow-up (P > .05). The comparison of IKDC extension and flexion deficit scores between the 2 groups showed no significant differences. Eleven patients in the ALR group and 4 in the TLR group complained of medial knee pain. The comparison between the 2 groups showed no significant difference (P > .05). CONCLUSIONS: The clinical outcomes of this study showed that no major difference existed in the ALR and TLR groups based on IKDC scores and medial opening evaluations in the short-term. However, TLR offered better rotatory stability than ALR at final follow-up. LEVEL OF EVIDENCE: Level II, lesser-quality randomized controlled trial. SN - 1526-3231 UR - https://www.unboundmedicine.com/medline/citation/25753825/Surgical_Treatment_of_Acute_Grade_III_Medial_Collateral_Ligament_Injury_Combined_With_Anterior_Cruciate_Ligament_Injury:_Anatomic_Ligament_Repair_Versus_Triangular_Ligament_Reconstruction_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0749-8063(14)00987-6 DB - PRIME DP - Unbound Medicine ER -