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Short- to mid-term outcomes of anatomic MCL reconstruction with Achilles tendon allograft after multiligament knee injury.
Knee Surg Sports Traumatol Arthrosc 2018; 26(10):2952-2959KS

Abstract

PURPOSE

Multiple techniques have been described in the literature for reconstruction of the medial collateral ligament. The purpose of this study is to describe functional outcome, range of motion, and knee stability following anatomic MCL reconstruction utilizing an Achilles tendon bone allograft after multiligament knee injury.

METHODS

A comprehensive search of a single-hospital multiligament knee injury (MLKI) procedural database was conducted to identify all patients that underwent reconstruction of the MCL utilizing an Achilles tendon bone allograft and with 2-year clinical follow-up. Medical charts were retrospectively reviewed to determine each patient's knee dislocation (KD) grade, final range of motion, stability on clinical examination, and the incidence of complications and reoperations. KOOS, IKDC, and Marx scores were also collected.

RESULTS

Thirty-two knees in 32 patients (21 males and 11 females) with a mean age of 30 years (range 15-51) were followed for an average of 40 months (range 28-87 months) following MCL reconstruction with Achilles tendon bone allograft. For patients with multiligament knee injuries, there were 14 KD-I (11 ACL/MCL; 3 MCL/PCL; 1 MCL/ACL/LCL; 1 MCL/PCL/LCL), 12 KD 3-M, and 3 KD-IV. One patient underwent isolated revision MCL reconstruction. At final follow-up, clinically significant valgus laxity was observed in only 1 patient (3%). All patients were able to achieve full extension of the knee and the average flexion was 121.1 ± 19.6. The average IKDC score was 67.6 ± 19.9 (range 27.7-98.9), the average KOOS score 77.1 ± 16.8 (range 31-100). The average Marx score was 4.9 (range 0-16, SD 5.2). Thirty-one of 32 (96%) patients reported being satisfied with results of the surgery. Knee dislocation grades were significantly correlated with post-operative outcome measures.

CONCLUSION

In a series utilizing a modified Marx Achilles tendon, MCL reconstruction in the setting of MLKI demonstrated satisfactory clinical and functional outcomes, as well as patient satisfaction at short- to mid-term follow-up. Furthermore, knee dislocation grades were demonstrated to correlate with post-operative IKDC, KOOS, and Marx scores.

LEVEL OF EVIDENCE

Type IV.

Authors+Show Affiliations

Department of Orthopedic Sports Medicine, Mayo Clinic, Rochester, MN, 55905, USA.Department of Orthopedic Sports Medicine, Mayo Clinic, Rochester, MN, 55905, USA.Department of Orthopedic Sports Medicine, Mayo Clinic, Rochester, MN, 55905, USA.Department of Orthopedic Sports Medicine, Mayo Clinic, Rochester, MN, 55905, USA.Department of Orthopedic Sports Medicine, Mayo Clinic, Rochester, MN, 55905, USA.Department of Orthopedic Sports Medicine, Mayo Clinic, Rochester, MN, 55905, USA.Department of Orthopedic Sports Medicine, Mayo Clinic, Rochester, MN, 55905, USA. Levy.Bruce@mayo.edu.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29427218

Citation

Barrett, Ian J., et al. "Short- to Mid-term Outcomes of Anatomic MCL Reconstruction With Achilles Tendon Allograft After Multiligament Knee Injury." Knee Surgery, Sports Traumatology, Arthroscopy : Official Journal of the ESSKA, vol. 26, no. 10, 2018, pp. 2952-2959.
Barrett IJ, Krych AJ, Pareek A, et al. Short- to mid-term outcomes of anatomic MCL reconstruction with Achilles tendon allograft after multiligament knee injury. Knee Surg Sports Traumatol Arthrosc. 2018;26(10):2952-2959.
Barrett, I. J., Krych, A. J., Pareek, A., Johnson, N. R., Dahm, D. L., Stuart, M. J., & Levy, B. A. (2018). Short- to mid-term outcomes of anatomic MCL reconstruction with Achilles tendon allograft after multiligament knee injury. Knee Surgery, Sports Traumatology, Arthroscopy : Official Journal of the ESSKA, 26(10), pp. 2952-2959. doi:10.1007/s00167-018-4843-4.
Barrett IJ, et al. Short- to Mid-term Outcomes of Anatomic MCL Reconstruction With Achilles Tendon Allograft After Multiligament Knee Injury. Knee Surg Sports Traumatol Arthrosc. 2018;26(10):2952-2959. PubMed PMID: 29427218.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Short- to mid-term outcomes of anatomic MCL reconstruction with Achilles tendon allograft after multiligament knee injury. AU - Barrett,Ian J, AU - Krych,Aaron J, AU - Pareek,Ayoosh, AU - Johnson,Nicholas R, AU - Dahm,Diane L, AU - Stuart,Michael J, AU - Levy,Bruce A, Y1 - 2018/02/09/ PY - 2017/08/10/received PY - 2018/01/24/accepted PY - 2018/2/11/pubmed PY - 2018/12/19/medline PY - 2018/2/11/entrez KW - Achilles tendon allograft KW - Ligament reconstruction KW - MCL reconstruction KW - Medial collateral ligament KW - Reconstruction SP - 2952 EP - 2959 JF - Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA JO - Knee Surg Sports Traumatol Arthrosc VL - 26 IS - 10 N2 - PURPOSE: Multiple techniques have been described in the literature for reconstruction of the medial collateral ligament. The purpose of this study is to describe functional outcome, range of motion, and knee stability following anatomic MCL reconstruction utilizing an Achilles tendon bone allograft after multiligament knee injury. METHODS: A comprehensive search of a single-hospital multiligament knee injury (MLKI) procedural database was conducted to identify all patients that underwent reconstruction of the MCL utilizing an Achilles tendon bone allograft and with 2-year clinical follow-up. Medical charts were retrospectively reviewed to determine each patient's knee dislocation (KD) grade, final range of motion, stability on clinical examination, and the incidence of complications and reoperations. KOOS, IKDC, and Marx scores were also collected. RESULTS: Thirty-two knees in 32 patients (21 males and 11 females) with a mean age of 30 years (range 15-51) were followed for an average of 40 months (range 28-87 months) following MCL reconstruction with Achilles tendon bone allograft. For patients with multiligament knee injuries, there were 14 KD-I (11 ACL/MCL; 3 MCL/PCL; 1 MCL/ACL/LCL; 1 MCL/PCL/LCL), 12 KD 3-M, and 3 KD-IV. One patient underwent isolated revision MCL reconstruction. At final follow-up, clinically significant valgus laxity was observed in only 1 patient (3%). All patients were able to achieve full extension of the knee and the average flexion was 121.1 ± 19.6. The average IKDC score was 67.6 ± 19.9 (range 27.7-98.9), the average KOOS score 77.1 ± 16.8 (range 31-100). The average Marx score was 4.9 (range 0-16, SD 5.2). Thirty-one of 32 (96%) patients reported being satisfied with results of the surgery. Knee dislocation grades were significantly correlated with post-operative outcome measures. CONCLUSION: In a series utilizing a modified Marx Achilles tendon, MCL reconstruction in the setting of MLKI demonstrated satisfactory clinical and functional outcomes, as well as patient satisfaction at short- to mid-term follow-up. Furthermore, knee dislocation grades were demonstrated to correlate with post-operative IKDC, KOOS, and Marx scores. LEVEL OF EVIDENCE: Type IV. SN - 1433-7347 UR - https://www.unboundmedicine.com/medline/citation/29427218/Short__to_mid_term_outcomes_of_anatomic_MCL_reconstruction_with_Achilles_tendon_allograft_after_multiligament_knee_injury_ L2 - https://dx.doi.org/10.1007/s00167-018-4843-4 DB - PRIME DP - Unbound Medicine ER -