TREATMENT OF SEVERE MEDIAL COLLATERAL LIGAMENT RUPTURE IN MULTI-LIGAMENT INJURY_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 ZHANGHangzhou ¹ , LIANGQingwei ¹ , LEIZeming ² , LIUXiangnan ² , BAIXizhuang ²

1. Department of Sports Medicine and Joint Surgery/Orthopaedics, the First Affiliated Hospital of China Medical University, Shenyang Liaoning, 110001, P. R. China;
2. Department of Sports Medicine/Joint Surgery, People's Hospital of Liaoning Province;

Corresponding author：

ZHANGHangzhou, Email: zhanghz1000@163.com

Keywords：

Knee; Multi-ligament injury; Medial collateral ligament; Joint stability

DOI：

10.7507/1002-1892.20160194

Video：

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Objective To compare the clinical efficacy between medial collateral ligament (MCL) repair and MCL reconstruction in multi-ligament injury. Methods Thirty-one patients with MCL rupture and multi-ligament injury of knee joint were treated between August 2008 and August 2012, and the clinical data were retrospectively analyzed. Of 31 patients, 11 cases underwent MCL repair (repair group), and 20 cases underwent MCL reconstruction (reconstruction group). There was no significant difference in gender, age, body mass, injury side, injury cause, and preoperative knee Lyshlom score, International Knee Documentation Committee (IKDC) subjective score, range of motion, and medial joint opening between 2 groups (P > 0.05). The postoperative knee subjective function and stability were compared between 2 groups. Results All incisions healed by first intention, and no postoperative complication occurred. All patients were followed up 2-4 years (mean, 3.2 years). At 2 years after operation, the IKDC subjective score, Lyshlom score, and range of motion were significantly increased in 2 groups when compared with preoperative ones (P < 0.05). The range of motion of reconstruction group was significantly better than that of repair group (P < 0.05). No significant difference was found in IKDC subjective score and Lyshlom score between 2 groups (P > 0.05). The medial joint opening was significantly improved in 2 groups at 2 years after operation when compared with preoperative one (P < 0.05), but no significant difference was found between 2 groups (P > 0.05). Conclusion Both the MCL reconstruction and MCL repair can restore medial stability in multi-ligament injury, but MCL reconstruction is better than MCL repair in range of motion.

Citation： ZHANGHangzhou, LIANGQingwei, LEIZeming, LIUXiangnan, BAIXizhuang. TREATMENT OF SEVERE MEDIAL COLLATERAL LIGAMENT RUPTURE IN MULTI-LIGAMENT INJURY. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(8): 956-960. doi: 10.7507/1002-1892.20160194 Copy

1.	Wijdicks CA, Griffith CJ, Johansen S, et al. Injuries to the medial collateral ligament and associated medial structures of the knee. J Bone Joint Surg (Am), 2010, 92(5):1266-1280.
2.	Liu X, Feng H, Zhang H, et al. Surgical treatment of subacute and chronic valgus instability in multiligament-injured knees with superficial medial collateral ligament reconstruction using Achilles allografts:a quantitative analysis with a minimum 2-year follow-up. Am J Sports Med, 2013, 41(5):1044-1050.
3.	Blanke F, Vonwehren L, Pagenstert G, et al. Surgical technique for treatment of concomitant grade Ⅱ MCL lesion in patients with ACL rupture. Acta Orthop Belg, 2015, 81(3):442-446.
4.	Prince MR, Blackman AJ, King AH, et al. Open anatomic reconstruction of the medial collateral ligament and posteromedial corner. Arthrosc Tech, 2015, 4(6):e885-890.
5.	Dong J, Wang XF, Men X, et al. Surgical treatment of acute grade Ⅲ medial collateral ligament injury combined with anterior cruciate ligament injury:Anatomic ligament repair versus triangular ligament reconstruction. Arthroscopy, 2015, 31(6):1108-1116.
6.	Edson CJ. Conservative and postoperative rehabilitation of isolated and combined injuries of the medial collateral ligament. Sports Med Arthrosc, 2006, 14(2):105-110.
7.	Miyamoto RG, Bosco JA, Sherman OH. Treatment of medial collateral ligament injuries. J Am Acad Orthop Surg, 2009, 17(3): 152-161.
8.	Duffy PS, Miyamoto RG. Management of medial collateral ligament injuries in the knee:an update and review. Phys Sportsmed, 2010, 38(2):48-54.
9.	Adravanti P, Dini F, Calafiore G, et al. Medial collateral ligament reconstruction during TKA:a new approach and surgical technique. Joints, 2016, 3(4):215-217.
10.	Madonna V, Screpis D, Condello V, et al. A novel technique for combined medial collateral ligament and posterior oblique ligament reconstruction:technical note. Knee Surg Sports Traumatol Arthrosc, 2015, 23(10):2814-2819.
11.	Fanelli GC, Fanelli DG. Management of chronic combined PCL medial posteromedial instability of the knee. Sports Med Arthrosc, 2015, 23(2):96-103.
12.	Roth J, Taylor DC. Management of acute isolated medial and posteromedial instability of the knee. Sports Med Arthrosc, 2015, 23(2):71-76.
13.	Lubowitz JH, MacKay G, Gilmer B. Knee medial collateral ligament and posteromedial corner anatomic repair with internal bracing. Arthrosc Tech, 2014, 3(4):e505-508.
14.	Zhang H, Sun Y, Han X, et al. Simultaneous reconstruction of the anterior cruciate ligament and medial collateral ligament in patients with chronic ACL-MCL lesions:A minimum 2-year follow-up study. Am J Sports Med, 2014, 42(7):1675-1681.
15.	Dong J, Ji G, Zhang Y, et al. Single allograft medial collateral ligament and posterior oblique ligament reconstruction:a technique to improve valgus and rotational stability. Eur J Orthop Surg Traumatol, 2014, 24(6):1025-1029.
16.	Koga H, Muneta T, Yagishita K, et al. Surgical management of grade[3] medial knee injuries combined with cruciate ligament injuries. Knee Surg Sports Traumatol Arthrosc, 2012, 20(1):88-94.
17.	Roth J, Taylor DC. Management of acute isolated medial and posteromedial instability of the knee. Sports Med Arthrosc, 2015, 23(2):71-76.
18.	Deo S, Getgood A. A technique of superficial medial collateral ligament reconstruction using an adjustable-loop suspensory fixation device. Arthrosc Tech, 2015, 4(3):e261-265.
19.	Lind M, Jakobsen BW, Lund B, et al. Anatomical reconstruction of the medial collateral ligament and posteromedial corner of the knee in patients with chronic medial collateral ligament instability. Am J Sports Med, 2009, 37(6):1116-1122.
20.	Kim SJ, Lee DH, Kim TE, et al. Concomitant reconstruction of the medial collateral and posterior oblique ligaments for medial instability of the knee. J Bone Joint Surg (Br), 2008, 90(10):1323-1327.
21.	Marx RG, Hetsroni I. Surgical technique:medial collateral ligament reconstruction using Achilles allograft for combined knee ligament injury. Clin Orthop Relat Res, 2012, 470(3):798-805.

1. Wijdicks CA, Griffith CJ, Johansen S, et al. Injuries to the medial collateral ligament and associated medial structures of the knee. J Bone Joint Surg (Am), 2010, 92(5):1266-1280.
2. Liu X, Feng H, Zhang H, et al. Surgical treatment of subacute and chronic valgus instability in multiligament-injured knees with superficial medial collateral ligament reconstruction using Achilles allografts:a quantitative analysis with a minimum 2-year follow-up. Am J Sports Med, 2013, 41(5):1044-1050.
3. Blanke F, Vonwehren L, Pagenstert G, et al. Surgical technique for treatment of concomitant grade Ⅱ MCL lesion in patients with ACL rupture. Acta Orthop Belg, 2015, 81(3):442-446.
4. Prince MR, Blackman AJ, King AH, et al. Open anatomic reconstruction of the medial collateral ligament and posteromedial corner. Arthrosc Tech, 2015, 4(6):e885-890.
5. Dong J, Wang XF, Men X, et al. Surgical treatment of acute grade Ⅲ medial collateral ligament injury combined with anterior cruciate ligament injury:Anatomic ligament repair versus triangular ligament reconstruction. Arthroscopy, 2015, 31(6):1108-1116.
6. Edson CJ. Conservative and postoperative rehabilitation of isolated and combined injuries of the medial collateral ligament. Sports Med Arthrosc, 2006, 14(2):105-110.
7. Miyamoto RG, Bosco JA, Sherman OH. Treatment of medial collateral ligament injuries. J Am Acad Orthop Surg, 2009, 17(3): 152-161.
8. Duffy PS, Miyamoto RG. Management of medial collateral ligament injuries in the knee:an update and review. Phys Sportsmed, 2010, 38(2):48-54.
9. Adravanti P, Dini F, Calafiore G, et al. Medial collateral ligament reconstruction during TKA:a new approach and surgical technique. Joints, 2016, 3(4):215-217.
10. Madonna V, Screpis D, Condello V, et al. A novel technique for combined medial collateral ligament and posterior oblique ligament reconstruction:technical note. Knee Surg Sports Traumatol Arthrosc, 2015, 23(10):2814-2819.
11. Fanelli GC, Fanelli DG. Management of chronic combined PCL medial posteromedial instability of the knee. Sports Med Arthrosc, 2015, 23(2):96-103.
12. Roth J, Taylor DC. Management of acute isolated medial and posteromedial instability of the knee. Sports Med Arthrosc, 2015, 23(2):71-76.
13. Lubowitz JH, MacKay G, Gilmer B. Knee medial collateral ligament and posteromedial corner anatomic repair with internal bracing. Arthrosc Tech, 2014, 3(4):e505-508.
14. Zhang H, Sun Y, Han X, et al. Simultaneous reconstruction of the anterior cruciate ligament and medial collateral ligament in patients with chronic ACL-MCL lesions:A minimum 2-year follow-up study. Am J Sports Med, 2014, 42(7):1675-1681.
15. Dong J, Ji G, Zhang Y, et al. Single allograft medial collateral ligament and posterior oblique ligament reconstruction:a technique to improve valgus and rotational stability. Eur J Orthop Surg Traumatol, 2014, 24(6):1025-1029.
16. Koga H, Muneta T, Yagishita K, et al. Surgical management of grade[3] medial knee injuries combined with cruciate ligament injuries. Knee Surg Sports Traumatol Arthrosc, 2012, 20(1):88-94.
17. Roth J, Taylor DC. Management of acute isolated medial and posteromedial instability of the knee. Sports Med Arthrosc, 2015, 23(2):71-76.
18. Deo S, Getgood A. A technique of superficial medial collateral ligament reconstruction using an adjustable-loop suspensory fixation device. Arthrosc Tech, 2015, 4(3):e261-265.
19. Lind M, Jakobsen BW, Lund B, et al. Anatomical reconstruction of the medial collateral ligament and posteromedial corner of the knee in patients with chronic medial collateral ligament instability. Am J Sports Med, 2009, 37(6):1116-1122.
20. Kim SJ, Lee DH, Kim TE, et al. Concomitant reconstruction of the medial collateral and posterior oblique ligaments for medial instability of the knee. J Bone Joint Surg (Br), 2008, 90(10):1323-1327.
21. Marx RG, Hetsroni I. Surgical technique:medial collateral ligament reconstruction using Achilles allograft for combined knee ligament injury. Clin Orthop Relat Res, 2012, 470(3):798-805.

Chinese Journal of Reparative and Reconstructive Surgery

TREATMENT OF SEVERE MEDIAL COLLATERAL LIGAMENT RUPTURE IN MULTI-LIGAMENT INJURY

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