Anatomic medial knee reconstruction restores stability and function at minimum 2 years follow-up

Abstract

PurposeChronic grade 3 tears of the medial collateral ligament and posterior oblique ligament may result in valgus laxity and anteromedial rotational instability after an isolated or multiligament injury. The purpose of this study was to prospectively analyze the restoration of physiologic medial laxity as assessed on stress radiography and patient reported subjective functional outcomes in patients who undergo an anatomic medial knee reconstruction. MethodsThis was a prospective study which included patients with chronic (> 6 weeks old) posteromedial corner injury with or without other ligament and meniscus lesions. Pre‐ and post‐operative valgus stress radiographs were performed in 20° knee flexion and functional outcome was recorded as per the International Knee Documentation Committee (IKDC) and Lysholm scores. All patients underwent anatomic medial reconstruction with two femoral and two tibial sockets using ipsilateral hamstring tendon autograft. Simultaneous ligament and meniscus surgery was performed as per the associated injury pattern. All patients were followed up for a minimum of 24 months post‐surgery. ResultsThirty‐four patients (23 males, 11 females) were enrolled in the study and all were available till final follow‐up of mean 49.7 ± 14.9 months. The mean age was 30.6 ± 7.9 (18–52 years). Two patients had isolated medial sided lesions and 23 had associated ligament injuries. The mean follow up was 49.7 (24–72) months. The mean IKDC score improved from 58 ± 8.3 to 78.2 ± 9.5 (p < 0.001). Post‐operatively there were 15 excellent, 11 good and 8 fair outcomes on Lysholm score. The mean pre‐operative valgus side‐to‐side opening improved from 7.5 ± 2.5 mm to 1.2 ± 0.7 mm on stress radiography (p < 0.001). ConclusionAnatomic reconstruction of the superficial medial collateral and posterior oblique ligaments restore stability in a consistent manner cases of chronic grade 3 instability. The objective functional results, subjective outcomes and measures of static medial stability are satisfactory in the short term. Level of EvidenceIV

The Control of Anteromedial Rotatory Instability Is Improved With Combined Flat sMCL and Anteromedial Reconstruction

“…16,21 Residual MCL laxity can impair knee function, cause chronic pain, and lead to higher rates of ACL reconstruction failure. 1,2,5,31,40 Combined ACL/MCL reconstruction can afford good clinical results, 21,32,34 but these are currently inferior to those after isolated ACL reconstruction. 21 In a recent registry study, 1-year postoperative Knee injury and Osteoarthritis Outcome Score and Tegner scores were higher after isolated ACL reconstruction compared with combined ACL/MCL reconstruction.…”

A Triple-Strand Anatomic Medial Collateral Ligament Reconstruction Restores Knee Stability More Completely Than a Double-Strand Reconstruction: A Biomechanical Study In Vitro

“… 5 , 14 Clinical studies of MCL reconstruction have measured satisfactory restoration of valgus stability but not rotational stability. 39 However, video analysis of ACL injuries in >100 professional soccer players showed that the most common mechanism was valgus (81%) and external rotation (ER; 66%). 11 Combined MCL + ACL injuries are prevalent in sports, 11 , 39 and the resulting valgus and ER instability 18 , 37 may remain after nonsurgical therapy of the MCL.…”

“… 39 However, video analysis of ACL injuries in >100 professional soccer players showed that the most common mechanism was valgus (81%) and external rotation (ER; 66%). 11 Combined MCL + ACL injuries are prevalent in sports, 11 , 39 and the resulting valgus and ER instability 18 , 37 may remain after nonsurgical therapy of the MCL. 34 , 41 Most MCL reconstructions have ignored the dMCL, but it is the largest single restraint to ER among the medial structures and ACL near knee extension, 5 and its transection during surgery allows pathological ER.…”

Current concepts on management of medial and posteromedial knee injuries

“…49 Of note-While performing anatomic MCL-POL, especially in a multiligament injury setting requiring further ACL/PCL/PLC reconstructions, the surgeons must keep tunnel coalitions in mind and must direct the guide pins in a correct direction to avoid tunnel coalition. 50 Although anatomic techniques have resulted in a good outcome, 51 there is a lack of evidence regarding the comparison between the results of anatomic vs. non-anatomic medial side reconstruction as surgeons have continued to prefer their modifications. 52 Nonetheless, it sounds logical to keep the reconstruction as anatomic as possible to avoid the possibility of failures.…”