title: Surgical management of grade 3 medial knee injuries combined with cruciate ligament injuries.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Retrospective case series, Level IV.
authors.affiliation: Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan. koga.orj@tmd.ac.jp
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Koga
authors.forename: Takeshi
authors.initials: T
authors.lastname: Muneta
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Yagishita
authors.forename: Young-Jin
authors.initials: YJ
authors.lastname: Ju
authors.forename: Ichiro
authors.initials: I
authors.lastname: Sekiya
mesh_terms: D000293:Adolescent; D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery; D000070598:Anterior Cruciate Ligament Injuries; D059549:Anterior Cruciate Ligament Reconstruction; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000209:etiology / Q000601:surgery*; D007718:Knee Injuries / Q000150:complications / Q000601:surgery*; D008297:Male; D017888:Medial Collateral Ligament, Knee / Q000601:surgery; D017060:Patient Satisfaction; D016119:Posterior Cruciate Ligament / Q000293:injuries* / Q000601:surgery; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012189:Retrospective Studies; D013710:Tendons / Q000637:transplantation; D015599:Trauma Severity Indices; D016896:Treatment Outcome; D055815:Young Adult