Clinical outcome of primary medial collateral ligament-posteromedial corner repair with or without staged anterior cruciate ligament reconstruction

Preoperative medial knee instability is an underestimated risk factor for failure of revision ACL reconstruction

“…In the present study, surgical treatment of the medial side reduced the risk of failure of revision ACLR by a factor of 13. Nevertheless, this study showed a failure rate for augmented repair of the medial side in 18% (4 out of 22 augmented repairs) of the cases, and the results seem to be worse than the clinical results of augmented repairs in combination with primary ACLR in the literature [6,8,30]. The good clinical results of anatomical medial reconstruction with tendon grafts, for example, in studies by Funchal et al and Lind et al in combined MCL and primary ACLR, as well as the better objective knee joint stability achieved by Dong et al in anatomical reconstruction compared to repair, suggest that anatomical medial reconstruction with tendon grafts may be superior to repair [11,24].…”

Influence of posteromedial corner injuries on clinical outcome and second-look arthroscopic findings after allograft transtibial anterior cruciate ligament reconstruction

“…The MCL provides the primary valgus restraint in the flexed knee and is an external rotation stabilizer [ 20 , 21 ]. With extension, the PMC becomes the primary stabilizer to valgus stress and prevents posterior tibial translation [ 2 , 3 , 6 , 7 ]. Consequently, PMC injuries combined with ACL injuries are significantly different and more serious than isolated ACL rupture and make the knee unstable in valgus motion and rotations.…”

“…Current biomechanical studies have revealed that the PMC contributes approximately one-third of the restraint to valgus stress in the extended knee [ 2 , 6 ]. Furthermore, the posterior horn of the medial meniscus acts like a “brakestop,” providing anterior restraint in the absence of the anterior cruciate ligament (ACL) [ 7 ]. The ACL controls anterior movement of the tibia and inhibits extreme ranges of tibial rotation [ 8 ].…”

“…PMC injuries are frequently associated with other ligament injuries such as those of the ACL, posterior cruciate ligament (PCL), or MCL. In the past several decades, PMC injuries have been managed in different ways including surgical or non-surgical treatment [ 7 ], and there is still controversy regarding their treatment. However, in recent years, numerous orthopedic surgeons have focused on surgical management for PMC-involved high-energy multiligamentous knee injuries [ 7 , 10 – 13 ].…”

The multiple ligament-injured knee: When is primary repair an option?

“…Historically, high failure rates of primary repair of both cruciate and collateral ligaments have been reported [21][22][23]. With increased awareness of the importance of patient selection by only performing repairs on proximal or distal type tears that can be reapproximated to their insertion, and the recent developments of additional suture augmentation, which is thought to protect the repaired ligament during rehabilitation, better outcomes of primary repair have been reported [24][25][26][27]. However, concern remains regarding this procedure as high failure rates of anterior cruciate ligament (ACL) repair have been reported among adolescents [28], while much less is known regarding posterior cruciate ligament (PCL) repair as the literature is scarce [29][30][31].…”