2017 ISAKOS Biennial Congress ePoster #1809

 

Clinical Outcome of Primary Medial Collateral Ligament-Posteromedial Corner Repair With or Without Staged Anterior Cruciate Ligament Reconstruction.

Vivek Pandey, MBBS, MS(Orth), Udupi, Karnataka INDIA
Vikrant Khanna, MS(Orth), Mangalore, Karnataka INDIA
Kiran K.V. Acharya, MBBS, MS, Udupi, Karnataka INDIA

Kasturba Medical College, Manipal, Udupi, Karnataka , INDIA

FDA Status Cleared

Summary

Clinical outcome of posteromedial corner repair with or without Anterior cruciate ligament recocnstruction

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Abstract

Background

In combined injuries to the Superficial Medial collateral ligament (MCL) and Anterior cruciate ligament tears, the MCL tears are currently managed conservatively followed by ACL reconstruction. However, posteromedial corner (PMC) injury is not synonymous with MCL injuries as former provides valgus stability in the extended knee and internal rotatory stability whereas MCL provided valgus stability in 150-900 of flexion along with external rotation stability at the knee. Hence, combination of PMC-MCL tear is far more serious injury than isolated MCL tear leading to severe valgus and rotatory instability especially in the extended knee, and hence requires operative attention. After the primary management of PMC and MCL, the next attention is on ACL reconstruction. However, the literature is still scarce on this aspect that whether adding further ACL reconstruction will certainly improve the clinical outcome or not. Our hypothesis was that operative management of MCL-PMC with or without ACL reconstruction will have similar outcome.
Study design: Level IV, retrospective cohort case series.

Methods

6-8 weeks after the MCL-PMC repair, all patients were given option of ACL reconstruction. However, a group of patient opted ‘not to undergo’ ACL reconstruction creating two cohorts with or with ACL reconstruction. A total of 35 patients of two groups [Group 1 (n=15): MCL-PMC repaired & ACL conserved; Group 2 (n=20): MCL-PMC repaired & ACL reconstructed] met the inclusion criteria with a minimum follow-up of two years. Mean age in group 1 and 2 was 35 (range, 21-51) and 36 years (range, 18-55) respectively with mean follow up of 50 and 47 months respectively. Clinical outcome measures included subjective feeling of instability, Lysholm and International knee documentation committee (IKDC) scores, KT-1000 measurement and range of motion (ROM) assessment.

Results

Mean Lysholm and IKDC scores of group 2 were significantly better than group 1 (Lysholm score: 94.6 vs 91.06; [p=0.017]: IKDC score: 86.3 vs 77.6 [p=0.02]). 90% of patients in group 2 (n=18) had normal or near normal knee IKDC scores as compared to only 60% (n=9) in group 1 (p=0.02). 60% (n=9) patients of group 1 complained of instability than none in the group 2 (p<0.0001). All the knees were stable in a valgus plane in both the groups. KT-1000 arthrometer revealed more anterior laxity in group 1 as compared to group 2 (p<0.001). 40% (n=6) patient of group 1 and 30% (n=6) of group 2 had loss in flexion range of motion. The mean loss of ROM in group 1 and 2 was 120 and 90 respectively. However, two groups did not show any significant difference in clinical scores when loss of motion was compared.

Conclusions

Primary MCL-PMC repair renders the knee stable in coronal plane in both the groups without any significant valgus laxity. However, ACL reconstruction adds on to the stability of the knee providing a superior clinical result. Hence, it is recommended to perform ACL reconstruction to avoid instability. Although stiffness remains a primary concern after primary MCL-PMC repair but it does not result in any significant adverse effect on clinical outcome.