2015 ISAKOS Biennial Congress Paper #0

Acute Percutaneous Repair of Medial Collateral Ligament in the Multiligamentous Injured Knee Results in Minimal Medial Laxity

Kurt S. Holuba, BA, New York, NY UNITED STATES
Harmen D. Vermeijden, MD, New York, New York UNITED STATES
Xiuyi A Yang, M.S., New York, NEW YORK UNITED STATES
Robert O'Brien, MHS, PA-C, New York, NY UNITED STATES
Jelle P. van der List, MD, PhD, Amsterdam NETHERLANDS
Gregory S. Difelice, MD, New York, NY UNITED STATES
Hospital for Special Surgery, New York, New York, UNITED STATES

FDA Status Not Applicable

Summary: Acute MCL repair in the setting of multiligamentous knee injuries results in minimal valgus laxity, minimal complications, good subjective outcomes and excellent stability at short-term follow-up.

Abstract:

Background

The treatment of grade III superficial medial collateral ligament (sMCL) tears in the setting of a multi-ligamentous injured knee (MLIK) is still under debate. It remains unclear whether a nonoperative or operative treatment approach is superior.

Aim

To assess the clinical and patient-reported outcome measures (PROMs) of acute sMCL repair with suture augmentation (SA) in the setting of an MLIK at 2-year follow-up.

Methods

A retrospective analysis of consecutive MLIK patients with grade III sMCL injuries, who underwent acute (<6 weeks) sMCL repair with SA, was conducted. Clinical follow-up was performed at minimum 1 year postoperatively and PROMs were collected at the latest follow-up (minimum 2 years postoperatively). Continuous variables were reported in median with interquartile range (IQR).

Level of Evidence: Level IV, Case Series

Results

A total of 20 patients (median age 41.4, IQR 28.5 – 47.9) with grade III sMCL injury and additional injury to one cruciate ligament (KDI-M; n=13) or bicrutiate (KDIII-M; n=7) were enrolled with a median follow-up of 4.3 (3.6 – 5.2) years. At a median final clinical follow-up of 4.2 (3.0 – 4.9) years, valgus laxity stress testing in 0 and 30° was negative in 18 patients (90.0%), grade I in two (10.0%), and grade II or III (= clinical failure) in no patients. Two patients (10.0%) required reoperation (arthrofibrosis, n=1; unicondylar knee arthroplasty, n=1), ACL failure was seen in four patients (21.0%), PCL failure in one (12.5%), and MCL failure in no patients. PROMs were excellent, at a median final follow-up of 4.2 (3.6 – 5.2) years, with median IKDC 82.2 (78.7–90.8), Lysholm 95.0 (90.0–100.0), modified Cincinnati Score 89.0 (83.3–96.0), SANE 90.0 (83.8 – 95.0), FJS 79.2 (62.5–91.7), Tegner 5.0 (IQR 4.0–6.0) and ACL-RSI 78.3 (IQR 66.7–90.0).

Conclusions

In a series of 20 heterogeneous patients with MLIK, outcomes of acute percutaneous MCL repair with SA of grade III sMCL injuries show encouraging results at short-term follow-up with excellent stability and PROMs. MCL repair with SA seems to reliably result in valgus stability, without the additional risk of arthrofibrosis nor the need for additional grafts or risk of tunnel convergence.