2015 ISAKOS Biennial Congress ePoster #1125

Surgical Repair of Medial Collateral Ligament and Posteromedial Corner Injuries of the Knee: A Systematic Review

Jeffrey DeLong, BS, MD, Charleston, SC UNITED STATES
Brian R. Waterman, MD, Winston-Salem, NC UNITED STATES

Medical University of South Carolina, Charleston, SC, USA

FDA Status Not Applicable

Summary: A systematic review of outcomes of primary repair of the medial collateral ligament and associated medial structures of the knee.

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Abstract:

Purpose

The purpose of this study was to systematically review outcomes of primary repair of the medial collateral ligament (MCL) and associated medial structures of the knee.

Methods

A systematic search of Medline/PubMed Database (1966 to May 2014), reference list scanning and citation searches of included articles, and manual searches of high impact journals (2000 to July 2013) and conference proceedings (2009 to July 2013) were performed to identify publications describing MCL repair techniques of the knee. Exclusion criteria included: (1) MCL reconstruction techniques, (2) animal models, (4) non-relevant study design, (5) and foreign language articles without available interpretation.

Clinical studies were descriptively analyzed and assessed for multiple outcomes of interest: level of evidence, concomitant ligamentous procedures, duration and extent of patient follow-up, laxity on radiographic and/or manual stress valgus testing, International Knee Documentation Committee (IKDC) objective form valgus stability subscore, Lysholm scores, and other patient-reported outcome measures. To further quantify the repair outcomes, absolute or relative medial joint space widening on valgus stress testing with the knee flexed to 20 to 30 degrees, percentage of patients with relative medial joint space widening less than 3 mm on valgus stress, and percentage of patients with an IKDC valgus stability grade A (normal) or B (near normal) were also evaluated.

Results

The online Pubmed/MEDLINE database search produced an overall total of 159 publications. Following exclusion of duplicate and non-relevant articles, 139 abstracts were assessed for eligibility. Full-text articles were obtained for 79 articles and were evaluated for inclusion and exclusion criteria. An additional 21 publications were identified through secondary screening measures. After applying exclusion criteria, a total of 16 unique references describing outcomes for repair of the medial collateral ligament of the knee were included in the final systematic review.

Discussion And Conclusion

This systematic review demonstrated that variations in repair techniques utilized have been dependent on the extent of the medial knee injuries. Variations, such as, direct suturing, suture anchors, and bone tunnels vary with the extent of capsular damage, rupture or avulsion of MCL insertions, injuries to the posteromedial corner structures, and the specific morphologic tear pattern and injury location of the MCL. Furthermore, numerous concomitant injuries prove difficulty in quantifying outcome data for meta-analysis of isolated primary repair of the MCL and associated structures. Further studies are required to better determine the effectiveness of specific primary repair techniques of isolated MCL injuries.