Increased risk of ACL revision with non-surgical treatment of a concomitant medial collateral ligament injury: a study on 19,457 patients from the Swedish National Knee Ligament Registry

Abstract

Purpose To determine how concomitant medial collateral ligament (MCL) and lateral collateral ligament (LCL) injuries affect outcome after anterior cruciate ligament (ACL) reconstruction. Methods Patients aged > 15 years who were registered in the Swedish National Knee Ligament Registry for primary ACL reconstruction between 2005 and 2016 were eligible for inclusion. Patients with a concomitant MCL or LCL injury were stratified according to collateral ligament treatment (non-surgical, repair or reconstruction), and one isolated ACL reconstruction group was created. The outcomes were ACL revision and the 2-year Knee Injury and Osteoarthritis Outcome Score (KOOS), which were analyzed using univariable and multivariable Cox regression and an analysis of covariance, respectively. Results A total of 19,457 patients (mean age 27.9 years, 59.4% males) met the inclusion criteria. An isolated ACL reconstruction implied a lower risk of ACL revision compared with presence of a non-surgically treated MCL injury (HR = 0.61 [95% CI 0.41–0.89], p = 0.0097) but not compared with MCL repair or reconstruction. A concomitant LCL injury did not impact the risk of ACL revision. Patients with a concomitant MCL or LCL injury reported inferior 2-year KOOS compared with isolated ACL reconstruction. The largest difference was found in the sports and recreation subscale across all groups, with MCL reconstruction resulting in the maximum difference (14.1 points [95% CI 4.3–23.9], p = 0.005). Conclusion Non-surgical treatment of a concomitant MCL injury in the setting of an ACL reconstruction may increase the risk of ACL revision. However, surgical treatment of the MCL injury was associated with a worse two-year patient-reported knee function. A concomitant LCL injury does not impact the risk of ACL revision compared with an isolated ACL reconstruction. Level of evidence Cohort study, Level III.

Medial collateral ligament injuries of the knee in male professional football players: a prospective three-season study of 130 cases from the UEFA Elite Club Injury Study

“…The football players in this cohort returned to play within a relatively short period, which suggests that the rehabilitation treatment was good and in line with what previous studies have reported after isolated MCL injuries [23, 27]. The MCL is an important stabiliser of the knee and, when injured in combination with the ACL, surgical treatment of the MCL may be necessary to restore knee joint stability [29], as a small increase in medial laxity may entail an increased risk of secondary consequences, such as the risk of ACL re-rupture and revision [30].…”

Length-change patterns of the medial collateral ligament and posterior oblique ligament in relation to their function and surgery

“…Perhaps, because of this, the present authors find the MCL the most difficult of the knee ligaments to reconstruct reliably. Registry data [ 31 ] have found that when an MCL injury in association with ACL rupture is treated conservatively, the likelihood of ACL graft failure is increased. These observations suggest the importance of improving the treatment of medial soft-tissue injuries.…”

Graft Choice for Anterior Cruciate Ligament Reconstruction With a Concomitant Non-surgically Treated Medial Collateral Ligament Injury Does Not Influence the Risk of Revision

“…A recent registry study reported that the non-surgical treatment of a concomitant MCL injury in the setting of an ACL reconstruction was associated with an increased risk of ACL revision; however, the impact of graft choice in this setting was not further investigated. 15 In addition, it is not known whether the preservation of the gracilis tendon may have a beneficial effect on the MCLdeficient knee, compared with harvesting both the ST and gracilis. The purpose of this study was therefore to compare the risk of ACL revision and the patientreported outcome after ACL reconstruction with a concomitant non-surgically treated MCL injury with regard to 3 ACL graft choices; the use of ST, the use of ST-G, and the use of patellar tendon (PT) autograft.…”