Summary

presented surgical technique improved both valgus and anterior stability, and led to excellent short term results at final follow up

Abstract

Introduction

Combined lesions of anterior cruciate ligament (ACL) and medial collateral ligament (MCL) are frequent in adult due to sports injury and trauma. In cases of chronic anterior cruciate ligament (ACL)-medial collateral ligament (MCL) lesions, nonoperative treatment of the MCL lesion may lead to chronic valgus instability and rotatory instability. The optimal management for patients who have combined ACL-MCL injuries remains controversial. Present study wants to evaluate the surgical technique for treatment of concomitant MCL and ACL lesion and report short term outcome result in our institute.

Purpose

To present a case series of 40 patients who underwent simultaneous ACL-MCL reconstruction with a year follow-up.
STUDY DESIGN:
Case series; Level of evidence, 4.

Methods

From October 2017 to December 2018, a total of 40 patients with chronic ACL-MCL injuries, for which the 2 ligaments were reconstructed arthroscopically during the same surgical procedure, were studied in National Institute of Traumatology and Orthopedics Rehabilitation(NITOR),Dhaka, Bangladesh. 40 Patients with chronic ACL rupture and grade III MCL-lesion were included. All patients received surgical treatment of concomitant MCL lesion by Ipsilateral semitendinosus tendon and ACL reconstruction by opposite semitendinosus with ipsilateral gracilis tendon All patients were available for follow-up for at least 1 years. The International Knee Documentation Committee (IKDC) subjective knee scores, valgus and sagittal stability, anteromedial rotatory stability, range of motion, and complications were assessed both preoperatively and postoperatively.

Results

At follow-up, valgus and sagittal laxity were not observed in any of the patients. The mean medial knee opening was significantly reduced to 0.80 ± 0.96 mm (range, -1.2 to 2.6 mm) postoperatively compared with 8.0 ± 1.3 mm (range, 6.1 to 10.7 mm) preoperatively (P < .01). The mean postoperative side-to-side difference measured with the KT-1000 arthrometer was reduced to 0.8 ± 0.9 mm (range, -1.2 to 2.3 mm) compared with 8.4 ± 1.6 mm (range, 6.2 to 13.2 mm) preoperatively (P < .01). Preoperative anteromedial instability was seen in 76% of patients (33/40), whereas none of the patients had anteromedial rotatory instability at the last follow-up. The mean IKDC subjective score improved overall from 45.3 ± 12.0 (range, 28.7-69.0) preoperatively to 87.7 ± 8.2 (range, 65.5-100.0) at the last follow-up (P < .01). Most patients (38/40) had normal or nearly normal range of motion of the knee joint; only 2 patient (5%) had a limitation of flexion of 15° compared with the contralateral knee at the last follow-up.

Conclusion

In patients with chronic ACL-MCL lesions, presented surgical technique with simultaneous reconstruction of the ACL and MCL can significantly improve the medial, sagittal, and rotatory stability of the knee at short-term follow-up.