Top

Knee Surgery, Sports Traumatology, Arthroscopy

Published in:

01-01-2012 | Knee

Surgical management of grade 3 medial knee injuries combined with cruciate ligament injuries

Authors: Hideyuki Koga, Takeshi Muneta, Kazuyoshi Yagishita, Young-Jin Ju, Ichiro Sekiya

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 1/2012

Abstract

Purpose

Although various surgical procedures have attempted to restore valgus stability in medial knee injuries, so far none has achieved satisfactory results. The purpose of this study was to assess clinical outcome for patients with grade 3 valgus instability who were treated according to our surgical management strategy.

Methods

Eighteen patients with both acute and chronic grade 3 medial knee injuries, all of which had combined cruciate ligament injuries, were treated with a proximal advancement of both the superficial medial collateral ligament (MCL) and posterior oblique ligament together with underlying deep MCL and joint capsule, in conjunction with cruciate ligament reconstructions in chronic phase. Augmentation with doubled semitendinosus tendon was added in 7 patients whose medial knee stability had been considered to be insufficient with only the proximal advancement procedure. They were evaluated preoperatively and at final follow-up.

Results

Manual valgus laxities at 0° and 30°, as well as side-to-side difference in medial joint opening in stress radiograph, were significantly improved at final follow-up. The Lysholm knee scale was also significantly improved. Median values of the subjective evaluations of the patients’ satisfaction, stability and sports performance level measured with visual analogue scale at final follow-up were 82 (60–100), 94 (71–100) and 88 (60–100), respectively.

Conclusions

Clinical outcomes of our surgical management strategy were reasonable in terms of restoring medial knee stability. This treatment protocol can help determine the surgical management of grade 3 medial knee injuries combined with cruciate ligament injuries.

Level of evidence

Retrospective case series, Level IV.

Anderson DR, Weiss JA, Takai S et al (1992) Healing of the medial collateral ligament following a triad injury: a biomechanical and histological study of the knee in rabbits. J Orthop Res 10:485–495PubMedCrossRef

Andersson C, Gillquist J (1992) Treatment of acute isolated and combined ruptures of the anterior cruciate ligament. A long-term follow-up study. Am J Sports Med 20:7–12PubMedCrossRef

Ballmer PM, Jakob RP (1988) The non operative treatment of isolated complete tears of the medial collateral ligament of the knee. A prospective study. Arch Orthop Trauma Surg 107:273–276PubMedCrossRef

Bin SI, Nam TS (2007) Surgical outcome of 2-stage management of multiple knee ligament injuries after knee dislocation. Arthroscopy 23:1066–1072PubMedCrossRef

Coobs BR, Wijdicks CA, Armitage BM et al (2010) An in vitro analysis of an anatomical medial knee reconstruction. Am J Sports Med 38:339–347PubMedCrossRef

Derscheid GL, Garrick JG (1981) Medial collateral ligament injuries in football. Nonoperative management of grade I and grade II sprains. Am J Sports Med 9:365–368PubMedCrossRef

Fanelli GC, Edson CJ (2002) Arthroscopically assisted combined anterior and posterior cruciate ligament reconstruction in the multiple ligament injured knee: 2- to 10-year follow-up. Arthroscopy 18:703–714PubMedCrossRef

Fetto JF, Marshall JL (1978) Medial collateral ligament injuries of the knee: a rationale for treatment. Clin Orthop Relat Res 132:206–218PubMed

Griffith CJ, Wijdicks CA, LaPrade RF et al (2009) Force measurements on the posterior oblique ligament and superficial medial collateral ligament proximal and distal divisions to applied loads. Am J Sports Med 37:140–148PubMedCrossRef

10.

Halinen J, Lindahl J, Hirvensalo E et al (2006) Operative and nonoperative treatments of medial collateral ligament rupture with early anterior cruciate ligament reconstruction: a prospective randomized study. Am J Sports Med 34:1134–1140PubMedCrossRef

11.

Halinen J, Lindahl J, Hirvensalo E (2009) Range of motion and quadriceps muscle power after early surgical treatment of acute combined anterior cruciate and grade-III medial collateral ligament injuries. A prospective randomized study. J Bone Joint Surg Am 91:1305–1312PubMedCrossRef

12.

Hara K, Niga S, Ikeda H et al (2008) Isolated anterior cruciate ligament reconstruction in patients with chronic anterior cruciate ligament insufficiency combined with grade II valgus laxity. Am J Sports Med 36:333–339PubMedCrossRef

13.

Hefti F, Muller W, Jakob RP et al (1993) Evaluation of knee ligament injuries with the IKDC form. Knee Surg Sports Traumatol Arthrosc 1:226–234PubMedCrossRef

14.

Holden DL, Eggert AW, Butler JE (1983) The nonoperative treatment of grade I and II medial collateral ligament injuries to the knee. Am J Sports Med 11:340–344PubMedCrossRef

15.

Hughston JC (1994) The importance of the posterior oblique ligament in repairs of acute tears of the medial ligaments in knees with and without an associated rupture of the anterior cruciate ligament. Results of long-term follow-up. J Bone Joint Surg Am 76:1328–1344PubMed

16.

Ibrahim SA (1999) Primary repair of the cruciate and collateral ligaments after traumatic dislocation of the knee. J Bone Joint Surg Br 81:987–990PubMedCrossRef

17.

Ibrahim SA, Ahmad FH, Salah M et al (2008) Surgical management of traumatic knee dislocation. Arthroscopy 24:178–187PubMedCrossRef

18.

Indelicato PA (1983) Non-operative treatment of complete tears of the medial collateral ligament of the knee. J Bone Joint Surg Am 65:323–329PubMed

19.

Inoue M, McGurk-Burleson E, Hollis JM et al (1987) Treatment of the medial collateral ligament injury. I: The importance of anterior cruciate ligament on the varus-valgus knee laxity. Am J Sports Med 15:15–21PubMedCrossRef

20.

Kovachevich R, Shah JP, Arens AM et al (2009) Operative management of the medial collateral ligament in the multi-ligament injured knee: an evidence-based systematic review. Knee Surg Sports Traumatol Arthrosc 17:823–829PubMedCrossRef

21.

Krackow KA, Thomas SC, Jones LC (1986) A new stitch for ligament-tendon fixation. Brief note. J Bone Joint Surg Am 68:764–766PubMed

22.

LaPrade RF, Engebretsen AH, Ly TV et al (2007) The anatomy of the medial part of the knee. J Bone Joint Surg Am 89:2000–2010PubMedCrossRef

23.

Laprade RF, Bernhardson AS, Griffith CJ et al (2010) Correlation of valgus stress radiographs with medial knee ligament injuries: an in vitro biomechanical study. Am J Sports Med 38:330–338PubMedCrossRef

24.

Mauck HP (1936) A new operative procedure for instability of the knee. J Bone Joint Surg 18:984–990

25.

Nagineni CN, Amiel D, Green MH et al (1992) Characterization of the intrinsic properties of the anterior cruciate and medial collateral ligament cells: an in vitro cell culture study. J Orthop Res 10:465–475PubMedCrossRef

26.

Osti L, Papalia R, Del Buono A et al (2010) Simultaneous surgical management of chronic grade-2 valgus instability of the knee and anterior cruciate ligament deficiency in athletes. Knee Surg Sports Traumatol Arthrosc 18:312–316PubMedCrossRef

27.

Owens BD, Neault M, Benson E et al (2007) Primary repair of knee dislocations: results in 25 patients (28 knees) at a mean follow-up of four years. J Orthop Trauma 21:92–96PubMedCrossRef

28.

Reider B, Sathy MR, Talkington J et al (1994) Treatment of isolated medial collateral ligament injuries in athletes with early functional rehabilitation. A five-year follow-up study. Am J Sports Med 22:470–477PubMedCrossRef

29.

Shelbourne KD, Porter DA (1992) Anterior cruciate ligament-medial collateral ligament injury: nonoperative management of medial collateral ligament tears with anterior cruciate ligament reconstruction. A preliminary report. Am J Sports Med 20:283–286PubMedCrossRef

30.

Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 198:43–49PubMed

31.

Woo SL, Inoue M, McGurk-Burleson E et al (1987) Treatment of the medial collateral ligament injury. II: Structure and function of canine knees in response to differing treatment regimens. Am J Sports Med 15:22–29PubMedCrossRef

32.

Yeh WL, Tu YK, Su JY et al (1999) Knee dislocation: treatment of high-velocity knee dislocation. J Trauma 46:693–701PubMedCrossRef

33.

Yoshiya S, Kuroda R, Mizuno K et al (2005) Medial collateral ligament reconstruction using autogenous hamstring tendons: technique and results in initial cases. Am J Sports Med 33:1380–1385PubMedCrossRef

Title: Surgical management of grade 3 medial knee injuries combined with cruciate ligament injuries
Authors: Hideyuki Koga
Takeshi Muneta
Kazuyoshi Yagishita
Young-Jin Ju
Ichiro Sekiya
Publication date: 01-01-2012
Publisher: Springer-Verlag
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 1/2012
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-011-1541-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Surgical management of grade 3 medial knee injuries combined with cruciate ligament injuries

Abstract

Purpose

Methods

Results

Conclusions

Level of evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Level of evidence

Please log in to get access to this content

Other articles of this Issue 1/2012

A prospective randomized comparison of irradiated and non-irradiated hamstring tendon allograft for ACL reconstruction

The history of KSSTA

Repair of osteochondral lesions in the knee by chondrocyte implantation using the MACI® technique

Use of transtibial aimer via the accessory anteromedial portal to identify the center of the ACL footprint

Combined unicompartmental knee arthroplasty and anterior cruciate ligament reconstruction

Surgery for anterior cruciate ligament deficiency: a historical perspective