title: 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.
abstract: BACKGROUND
  Symptomatic medial collateral ligament (MCL) instability is rare, and it is frequently associated with multiligament injuries. Most clinical investigations have failed to clearly define the specific objective outcome measures assessing the stability of the MCL quantitatively before and after the reconstruction procedure.
  
  
  OBJECTIVE
  To quantitatively evaluate the early clinical outcomes of patients with valgus instability of knee joints who had undergone superficial MCL reconstruction using Achilles tendon allografts.
  
  
  METHODS
  Case series; Level of evidence, 4.
  
  
  METHODS
  From August 2005 to December 2010, 19 consecutive patients with MCL injuries were included in this study. The inclusion criteria were (1) a subacute or chronic MCL injury, with a time from initial injury to surgery of longer than 3 weeks, and (2) valgus laxity graded C or D according to the International Knee Documentation Committee (IKDC). All patients underwent superficial MCL reconstruction using Achilles tendon allografts. To evaluate the laxity of the MCL preoperatively and postoperatively, valgus stress radiographs using a Telos device were used. Other assessments included the IKDC subjective functional evaluation and Lysholm score estimation.
  
  
  RESULTS
  Sixteen of the 19 patients (12 men and 4 women) were available for final follow-up. The median age of the patients was 37 years (range, 19-53 years); mean body mass index (BMI) was 26.4 (range, 21.7-29.4). The mean time from injury to surgery was 15.9 months (range, 24 days to 84 months), and median follow-up period was 34 months (range, 24-67 months). The mean medial knee laxity (side-to-side difference) was 8.9 ± 3.2 mm (range, 6-15.9 mm) preoperatively and 1.1 ± 0.9 mm (range, -1.1 to 3.2 mm) postoperatively (P < .001). The preoperative mean IKDC subjective knee functional score was 49.8 ± 6.9 (range, 31-57.5), while the postoperative functional score was 84.3 ± 6.0 (range, 71.3-93.1) (P < .001). The mean Lysholm score was 69.3 ± 5.9 (range, 55-78) preoperatively and 88.6 ± 5.0 (range, 75-95) postoperatively (P < .001). There was no significant correlation between patients' BMI and the final clinical outcome scores (P = .311).
  
  
  CONCLUSIONS
  In a small set of patients with multiligament-injured knees, valgus laxity can be effectively restored through surgical management with superficial MCL reconstruction, when the other associated ligament injuries are reconstructed as well. The subjective functional results were significantly improved postoperatively at short-term follow-up.
authors: Sports Medicine Service, Beijing Jishuitan Hospital, Xinjiekou East Street, Xicheng District, Beijing, China, 100035.
authors: Xin
authors: X
authors: Liu
authors: Hua
authors: H
authors: Feng
authors: Hui
authors: H
authors: Zhang
authors: Lei
authors: L
authors: Hong
authors: Xue Song
authors: XS
authors: Wang
authors: Jin
authors: J
authors: Zhang
authors: Jie Wei
authors: JW
authors: Shen
mesh_terms: D000125:Achilles Tendon / Q000637:transplantation; D000328:Adult; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007593:Joint Instability / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D007718:Knee Injuries / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D007719:Knee Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D017888:Medial Collateral Ligament, Knee / Q000293:injuries / Q000601:surgery*; D008875:Middle Aged; D011859:Radiography; D012720:Severity of Illness Index; D055815:Young Adult
keywords: Achilles allograft; stress radiograph; superficial medial collateral ligament reconstruction; valgus instability