Robert W Westermann1, Kurt P Spindler2, Laura J Huston3, Brian R Wolf4. 1. Department of Orthopaedics, University of Iowa Hospitals, Iowa City, Iowa, U.S.A.. Electronic address: robert-westermann@uiowa.edu. 2. Orthopaedic and Rheumatologic Institute, Cleveland Clinic Foundation, Garfield Heights, Ohio, U.S.A. 3. Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A. 4. Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, Iowa, U.S.A.
Abstract
PURPOSE: To evaluate differences in repair and nonoperatively managed grade III medial collateral ligament (MCL) injuries during anterior cruciate ligament (ACL) reconstruction. METHODS: Patients enrolled in a multicenter prospective longitudinal group who underwent unilateral primary ACL reconstruction between 2002 and 2008 were evaluated. Patients with concomitant grade III MCL injuries treated either operatively or nonoperatively were identified. Concurrent injuries, subsequent surgeries, surgical chronicity, and MCL tear location were analyzed. Patient-reported outcomes were measured at time of ACL reconstruction and 2-year follow-up. RESULTS: Initially, 3,028 patients were identified to have undergone primary ACL reconstruction during the time frame; 2,586 patients completed 2-year follow-up (85%). Grade III MCL tears were documented in 1.1% (27 of 2,586): 16 operatively managed patients and 11 nonoperatively treated MCLs during ACL reconstruction. The baseline Knee Injury and Osteoarthritis Outcome Score (KOOS) and International Knee Documentation Committee scores were lower in patients who underwent operative MCL treatment. Reoperation rates for arthrofibrosis were 19% after repair and 9% after conservative management (P = .48). At 2 years, both groups significantly improved; however, the nonoperative MCL group maintained superior patient-reported outcomes in terms of minimal clinically important differences, but these differences did not reach statistical significance (KOOS sports/recreation [88.2 vs 74.4, P = .10], KOOS knee-related quality of life [81.3 vs 68.4, P = .13], and International Knee Documentation Committee [87.6 vs 76.0, P = .14]). Tibial-sided MCL injuries were associated with clinically inferior baseline scores compared with femoral-sided MCL (KOOS knee-related quality of life, 34.4 vs 18.5, P = .09), but these differences resolved by 2 years. Surgical chronicity did not influence 2-year outcome. CONCLUSIONS: Both operative and nonoperative management of MCL tears in our patient group demonstrated clinical improvements between study enrollment and 2-year follow-up. MCL surgery during ACL reconstruction was assigned to patients with worse symptoms at enrollment and was associated with worse outcomes at 2 years. A subset of patients with severe combined ACL and medial knee injuries may benefit from operative management; however, that population has yet to be defined. LEVEL OF EVIDENCE: Level III, retrospective cohort.
PURPOSE: To evaluate differences in repair and nonoperatively managed grade III medial collateral ligament (MCL) injuries during anterior cruciate ligament (ACL) reconstruction. METHODS:Patients enrolled in a multicenter prospective longitudinal group who underwent unilateral primary ACL reconstruction between 2002 and 2008 were evaluated. Patients with concomitant grade III MCL injuries treated either operatively or nonoperatively were identified. Concurrent injuries, subsequent surgeries, surgical chronicity, and MCL tear location were analyzed. Patient-reported outcomes were measured at time of ACL reconstruction and 2-year follow-up. RESULTS: Initially, 3,028 patients were identified to have undergone primary ACL reconstruction during the time frame; 2,586 patients completed 2-year follow-up (85%). Grade III MCL tears were documented in 1.1% (27 of 2,586): 16 operatively managed patients and 11 nonoperatively treated MCLs during ACL reconstruction. The baseline Knee Injury and Osteoarthritis Outcome Score (KOOS) and International Knee Documentation Committee scores were lower in patients who underwent operative MCL treatment. Reoperation rates for arthrofibrosis were 19% after repair and 9% after conservative management (P = .48). At 2 years, both groups significantly improved; however, the nonoperative MCL group maintained superior patient-reported outcomes in terms of minimal clinically important differences, but these differences did not reach statistical significance (KOOS sports/recreation [88.2 vs 74.4, P = .10], KOOS knee-related quality of life [81.3 vs 68.4, P = .13], and International Knee Documentation Committee [87.6 vs 76.0, P = .14]). Tibial-sided MCL injuries were associated with clinically inferior baseline scores compared with femoral-sided MCL (KOOS knee-related quality of life, 34.4 vs 18.5, P = .09), but these differences resolved by 2 years. Surgical chronicity did not influence 2-year outcome. CONCLUSIONS: Both operative and nonoperative management of MCL tears in our patient group demonstrated clinical improvements between study enrollment and 2-year follow-up. MCL surgery during ACL reconstruction was assigned to patients with worse symptoms at enrollment and was associated with worse outcomes at 2 years. A subset of patients with severe combined ACL and medial knee injuries may benefit from operative management; however, that population has yet to be defined. LEVEL OF EVIDENCE: Level III, retrospective cohort.
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Authors: Daniel Guenther; Thomas Pfeiffer; Wolf Petersen; Andreas Imhoff; Mirco Herbort; Andrea Achtnich; Thomas Stein; Christoph Kittl; Christian Schoepp; Ralph Akoto; Jürgen Höher; Sven Scheffler; Amelie Stöhr; Thomas Stoffels; Julian Mehl; Tobias Jung; Andree Ellermann; Christian Eberle; Cara Vernacchia; Patricia Lutz; Matthias Krause; Natalie Mengis; Peter E Müller; Thomas Patt; Raymond Best Journal: Orthop J Sports Med Date: 2021-11-29