title: Surgical technique: does mini-invasive medial collateral ligament and posterior oblique ligament repair restore knee stability in combined chronic medial and ACL injuries?
abstract: BACKGROUND
  Residual laxity remains after ACL reconstruction in patients with combined chronic ACL and medial instability. The question arises whether to correct medial capsular and ligament injuries when Grade II and III medial laxity is present.
  
  
  METHODS
  We developed a mini-invasive medial ligament plasty to repair the medial collateral ligament to correct residual medial valgus and rotatory laxity after ACL reconstruction.
  
  
  METHODS
  We prospectively followed 36 patients with an ACL deficiency combined with chronic Grade II or III valgus and rotatory medial instability. The mean age was 37 years (range, 15-70 years). For all patients, we obtained preoperative and postoperative Knee Injury and Osteoarthritis Outcome, International Knee Documentation Committee, Lysholm, and Tegner Activity Level Scores. The minimum followup was 2 years (median, 3 years; range, 2-7 years).
  
  
  RESULTS
  The mean subjective International Knee Documentation Committee score improved from 36 preoperatively to 94 at the last followup. While all patients had an International Knee Documentation Committee score of Grade C or D preoperatively, no patient did postoperatively. The mean Knee Injury and Osteoarthritis Outcome Score improved from 45 preoperatively to 93 postoperatively. Valgus and external rotatory tests were negative in all patients. The mean Tegner activity level decreased from 7 preinjury to 6 postoperatively, and the mean Lysholm score improved from 40 preoperatively to 93 at last followup.
  
  
  CONCLUSIONS
  This simple technique restored medial stability and knee function to normal or nearly normal in all patients.
  
  
  METHODS
  Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Centre of Sports Traumatology, Koelliker Hospital, Corso Duca degli Abruzzi 30, 10129 Turin, Italy. canata@ortosport.it
authors.forename: Gian Luigi
authors.initials: GL
authors.lastname: Canata
authors.forename: Alfredo
authors.initials: A
authors.lastname: Chiey
authors.forename: Tommaso
authors.initials: T
authors.lastname: Leoni
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D059549:Anterior Cruciate Ligament Reconstruction; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000601:surgery*; D007718:Knee Injuries / Q000601:surgery*; D008023:Ligaments, Articular / Q000601:surgery*; D008297:Male; D017888:Medial Collateral Ligament, Knee / Q000601:surgery; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D019637:Orthopedic Procedures / Q000379:methods* / Q000534:rehabilitation; D013536:Suture Techniques; D055815:Young Adult