2015 ISAKOS Biennial Congress ePoster #1117

Anatomical Reconstruction of Superficial Medial Collateral Ligament of the Knee

Kazutoshi Kurokouchi, MD, PhD, Nagoya, Aichi JAPAN
Shigeo Takahashi, MD, PhD, Nagoya, Aichi JAPAN
Masaki Yoda, MD, PhD, Anjo, Aichi JAPAN
Ryuichiro Yamamoto, MD, PhD, Nagoya, Aichi JAPAN

Orthopaedics and Arthroscopy Center, Mitsubishi Nagoya Hospital, Nagoya, Aichi, JAPAN

FDA Status Not Applicable

Summary: Clinical Results of Anatomical Reconstruction of Superficial Medial Collateral Ligament of the Knee

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Abstract:

Objective

It is known that fresh medial collateral ligament (MCL) injuries can be adequately cured with conservative treatment. However, treatment is often difficult in chronic grade III MCL injuries. For chronic grade III MCL injuries, we have performed anatomical reconstruction of the superficial MCL with an autologous semitendinosus tendon. We investigated the clinical features of patients with chronic grade III MCL injuries. We also evaluated the postoperative results of our surgical treatment. METHODS: We assessed 63 of 74 patients who underwent reconstruction at two years or more of postoperative period. We excluded cases with osteoarthritis, posterolateral corner deficiency, repeated operations, and/or surgery for intercondylar eminence or tibial plateau fractures. There were 53 males and 10 females with an age range of 16-63 years (mean: 32.1 years). The causes of injury included traffic, falls or unexpected accidents in 23(3 females) cases, contact sports in 17(0) cases, and non-contact sports in 23(7) cases. Simultaneous reconstructions of the anterior cruciate ligament (ACL) and/or posterior cruciate ligament (PCL) were performed by using autologous bone-patellar-bone in 55 cases and/or semitendinosus tendon in 14 cases, respectively. We compared the pre- and postoperative results of medial joint space side-to-side differences on plain X-ray with valgus stress at 20 degrees of flexion (MJS), ROM, the Japanese Orthopaedic Association scores (JOA), and Lysholm Knee Score (LKS) in all cases. We also measured side-to-side differences with KT-1000 in anterior translation at 20 degrees of flexion with maximum anterior manual force (KT20) in ACL reconstruction cases and differences in total translation at 70 degrees of flexion with maximum posterior and anterior manual force (KT70) in cases of PCL reconstruction. RESULTS: The pre- and postoperative results were as follows, MJS: 4.9 ± 2.3 mm and -0.3 ± 1.0 mm; JOA: 47.8 ± 17.9 points and 92.0 ± 10.9 points; KTS: 64.4 ± 15.9 points and 95.7 ± 97.8 points; KT20: 10.1 ± 4.2 mm and 1.9 ± 2.3 mm; KT70: 12.5 ± 4.2 mm and 3.0 ± 1.7 mm. All of these results indicated significant improvement after surgery (p<0.001). No remarkable ROM deficits and complications were observed in all cases. DISCUSSION: Chronic grade III MCL injuries were mainly observed in the males and in the females after non-contact injuries. Most of all patients had accompanied with cruciate ligaments damages. For chronic grade III MCL injuries, normal medial knee stability was restored by our anatomical reconstruction of the superficial MCL with an autologous semitendinosus tendon. Consequently, the overall postoperative results, including cruciate ligament reconstruction, were satisfactory. Cases with chronic grade III MCL injuries, in contrast to those with fresh injuries, are not expected to experience spontaneous recovery. In addition, the superficial MCL plays important roles in knee stability as not only a primary restraint for valgus stress of the knee joint but also a secondary restraint for anterior/posterior stress of the knee joint. Our results thus suggest that we should take an anatomical reconstruction of the superficial MCL into consideration for chronic multiple knee ligament injuries complicated by grade III MCL injury.