title: 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.
abstract: BACKGROUND
  Early operative treatment of combined anterior cruciate and medial collateral ligament injuries has frequently led to motion complications and slow quadriceps muscle power gains. The purpose of the present study was to evaluate the effect of early repair or nonoperative treatment of a concomitant medial collateral ligament injury on range of motion of the knee and quadriceps muscle strength in patients with combined injuries.
  
  
  METHODS
  Forty-seven consecutive patients with combined anterior cruciate and grade-III medial collateral ligament injuries were randomized into two groups. The medial collateral ligament was repaired in Group I (n = 23) and was treated nonoperatively in Group II (n = 24). In both groups, the torn anterior cruciate ligament was treated with early reconstruction. The patients were evaluated on the basis of sequential range-of-motion measurements, the one-leg-hop test, and isokinetic muscle power measurements at the time of follow-up, and the findings were compared between the two treatment groups.
  
  
  RESULTS
  All patients achieved full knee extension. At all follow-up intervals the flexion deficit was greater in the group that had been managed with surgical repair of both ligaments, but the difference was significant only at six weeks (100 degrees compared with 112 degrees; p = 0.009), twelve weeks (119 degrees compared with 128 degrees; p = 0.043), and thirty-six weeks (130 degrees compared with 136 degrees; p = 0.011) after the operation. The difference between the groups was not significant at fifty-two weeks (132 degrees compared with 137 degrees) or 104 weeks (134 degrees compared with 137 degrees). The quadriceps muscle power deficit at fifty-two weeks was 30.7% in the group that had been managed with combined repair and 20.5% in the group that had been managed with anterior cruciate ligament reconstruction only (p = 0.015). At 104 weeks, the deficits were 14.4% and 9.7%, respectively (p = 0.2).
  
  
  CONCLUSIONS
  Early operative treatment of combined anterior cruciate and medial collateral ligament injuries is possible without increased long-term mobilization complications. The rehabilitation period is long, and aggressive physiotherapy is recommended. However, nonoperative treatment of the torn medial collateral ligament allows faster restoration of flexion and quadriceps muscle power. Our results favor nonoperative treatment of the torn medial collateral ligament in patients with combined injuries.
authors.affiliation: Department of Orthopedics and Traumatology, Helsinki University Central Hospital, Helsinki, Finland. jyrki.halinen@saunalahti.fi
authors.forename: Jyrki
authors.initials: J
authors.lastname: Halinen
authors.forename: Jan
authors.initials: J
authors.lastname: Lindahl
authors.forename: Eero
authors.initials: E
authors.lastname: Hirvensalo
mesh_terms: D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D001182:Arthroscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015601:Injury Severity Score; D007593:Joint Instability / Q000517:prevention & control; D007718:Knee Injuries / Q000175:diagnosis / Q000534:rehabilitation / Q000601:surgery*; D008297:Male; D017888:Medial Collateral Ligament, Knee / Q000293:injuries / Q000601:surgery*; D008875:Middle Aged; D053580:Muscle Strength / Q000502:physiology*; D011182:Postoperative Care / Q000379:methods; D011336:Probability; D011446:Prospective Studies; D052097:Quadriceps Muscle / Q000502:physiology; D016059:Range of Motion, Articular / Q000502:physiology*; D019651:Plastic Surgery Procedures / Q000379:methods; D020127:Recovery of Function; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D013536:Suture Techniques; D013997:Time Factors; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult