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Clinical outcome of primary medial collateral ligament-posteromedial corner repair with or without staged anterior cruciate ligament reconstruction.
Injury 2017; 48(6):1236-1242I

Abstract

INTRODUCTION

Medial collateral ligament (MCL) is a prime valgus stabilizer of the knee, and MCL tears are currently managed conservatively. However, posteromedial corner (PMC) injury along with MCL tear is not same as isolated MCL tear and the former is more serious injury and requires operative attention. However, literature is scarce about the management and outcome of PMC-MCL tear alongside anterior cruciate ligament (ACL) tear. The purpose of this study is to report the clinical outcome of primary repair of MCL and PMC with or without staged ACL reconstruction.

METHODS

A retrospective evaluation was performed on patients with MCL-PMC complex injury with ACL tear who underwent primary repair of MCL-PMC tear followed by rehabilitation. Further, several of them chose to undergo ACL reconstruction whereas rest opted conservative treatment for the ACL tear. A total of 35 patients of two groups [Group 1 (n=15): MCL-PMC repaired and ACL conserved; Group 2 (n=20): MCL-PMC repaired and ACL reconstructed] met the inclusion criteria with a minimum follow-up of two years. Clinical outcome measures included grade of valgus medial opening (0° extension and 30° flexion), Lysholm and International knee documentation committee (IKDC) scores, KT-1000 measurement, subjective feeling of instability, range of motion (ROM) assessment and complications.

RESULTS

While comparing group 2 versus group 1, mean Lysholm (94.6 vs. 91.06; p=0.017) and IKDC scores (86.3 vs. 77.6; p=0.011) of group 2 were significantly higher than group 1. 60% patients of group 1 complained of instability against none in the group 2 (p<0.0001). All the knees of both the groups were valgus stable with none requiring late reconstruction. The mean loss of flexion ROM in group 1 and 2 was 12° and 9° respectively which was not statistically different (p=0.41). However while considering the loss of motion, two groups did not show any significant difference in clinical scores.

CONCLUSIONS

Primary MCL-PMC repair renders the knee stable in coronal plane in both the groups and further ACL reconstruction adds on to the stability of the knee providing a superior clinical outcome. Minor knee stiffness remains a concern after primary MCL-PMC repair but without any unfavorable clinical effect.

Authors+Show Affiliations

Kasturba Medical College, Manipal, Manipal University, India. Electronic address: vivekortho@gmail.com.Kasturba Medical College, Manipal, Manipal University, India.Kasturba Medical College, Manipal, Manipal University, India.Kasturba Medical College, Manipal, Manipal University, India.Kasturba Medical College, Manipal, Manipal University, India.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28365070

Citation

Pandey, Vivek, et al. "Clinical Outcome of Primary Medial Collateral Ligament-posteromedial Corner Repair With or Without Staged Anterior Cruciate Ligament Reconstruction." Injury, vol. 48, no. 6, 2017, pp. 1236-1242.
Pandey V, Khanna V, Madi S, et al. Clinical outcome of primary medial collateral ligament-posteromedial corner repair with or without staged anterior cruciate ligament reconstruction. Injury. 2017;48(6):1236-1242.
Pandey, V., Khanna, V., Madi, S., Tripathi, A., & Acharya, K. (2017). Clinical outcome of primary medial collateral ligament-posteromedial corner repair with or without staged anterior cruciate ligament reconstruction. Injury, 48(6), pp. 1236-1242. doi:10.1016/j.injury.2017.03.021.
Pandey V, et al. Clinical Outcome of Primary Medial Collateral Ligament-posteromedial Corner Repair With or Without Staged Anterior Cruciate Ligament Reconstruction. Injury. 2017;48(6):1236-1242. PubMed PMID: 28365070.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical outcome of primary medial collateral ligament-posteromedial corner repair with or without staged anterior cruciate ligament reconstruction. AU - Pandey,Vivek, AU - Khanna,Vikrant, AU - Madi,Sandesh, AU - Tripathi,Anshul, AU - Acharya,Kiran, Y1 - 2017/03/22/ PY - 2016/12/25/received PY - 2017/03/09/revised PY - 2017/03/20/accepted PY - 2017/4/4/pubmed PY - 2018/4/24/medline PY - 2017/4/3/entrez KW - Acute posteromedial corner injury KW - Anterior cruciate ligament KW - Medial collateral ligament KW - Reconstruction KW - Repair SP - 1236 EP - 1242 JF - Injury JO - Injury VL - 48 IS - 6 N2 - INTRODUCTION: Medial collateral ligament (MCL) is a prime valgus stabilizer of the knee, and MCL tears are currently managed conservatively. However, posteromedial corner (PMC) injury along with MCL tear is not same as isolated MCL tear and the former is more serious injury and requires operative attention. However, literature is scarce about the management and outcome of PMC-MCL tear alongside anterior cruciate ligament (ACL) tear. The purpose of this study is to report the clinical outcome of primary repair of MCL and PMC with or without staged ACL reconstruction. METHODS: A retrospective evaluation was performed on patients with MCL-PMC complex injury with ACL tear who underwent primary repair of MCL-PMC tear followed by rehabilitation. Further, several of them chose to undergo ACL reconstruction whereas rest opted conservative treatment for the ACL tear. A total of 35 patients of two groups [Group 1 (n=15): MCL-PMC repaired and ACL conserved; Group 2 (n=20): MCL-PMC repaired and ACL reconstructed] met the inclusion criteria with a minimum follow-up of two years. Clinical outcome measures included grade of valgus medial opening (0° extension and 30° flexion), Lysholm and International knee documentation committee (IKDC) scores, KT-1000 measurement, subjective feeling of instability, range of motion (ROM) assessment and complications. RESULTS: While comparing group 2 versus group 1, mean Lysholm (94.6 vs. 91.06; p=0.017) and IKDC scores (86.3 vs. 77.6; p=0.011) of group 2 were significantly higher than group 1. 60% patients of group 1 complained of instability against none in the group 2 (p<0.0001). All the knees of both the groups were valgus stable with none requiring late reconstruction. The mean loss of flexion ROM in group 1 and 2 was 12° and 9° respectively which was not statistically different (p=0.41). However while considering the loss of motion, two groups did not show any significant difference in clinical scores. CONCLUSIONS: Primary MCL-PMC repair renders the knee stable in coronal plane in both the groups and further ACL reconstruction adds on to the stability of the knee providing a superior clinical outcome. Minor knee stiffness remains a concern after primary MCL-PMC repair but without any unfavorable clinical effect. SN - 1879-0267 UR - https://www.unboundmedicine.com/medline/citation/28365070/Clinical_outcome_of_primary_medial_collateral_ligament_posteromedial_corner_repair_with_or_without_staged_anterior_cruciate_ligament_reconstruction_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0020-1383(17)30154-7 DB - PRIME DP - Unbound Medicine ER -