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.
BACKGROUND
In cases of chronic anterior cruciate ligament (ACL)-medial collateral ligament (MCL) lesions, nonoperative treatment of the MCL lesion may lead to chronic valgus instability and rotatory instability. The optimal management for patients who have combined ACL-MCL injuries remains controversial.


OBJECTIVE
To present a case series of 21 patients who underwent simultaneous ACL-MCL reconstruction with a 2- to 5-year follow-up.


METHODS
Case series; Level of evidence, 4.


METHODS
From October 2007 to December 2010, a total of 21 patients with chronic ACL-MCL injuries, for which the 2 ligaments were reconstructed during the same surgical procedure, were studied. All patients were available for follow-up for at least 2 years. The International Knee Documentation Committee (IKDC) subjective knee scores, valgus and sagittal stability, anteromedial rotatory stability, range of motion, and complications were assessed both preoperatively and postoperatively.


RESULTS
At follow-up, valgus and sagittal laxity were not observed in any of the patients. The mean medial knee opening was significantly reduced to 0.80 ± 0.96 mm (range, -1.2 to 2.6 mm) postoperatively compared with 8.0 ± 1.3 mm (range, 6.1 to 10.7 mm) preoperatively (P < .01). The mean postoperative side-to-side difference measured with the KT-1000 arthrometer was reduced to 0.8 ± 0.9 mm (range, -1.2 to 2.3 mm) compared with 8.4 ± 1.6 mm (range, 6.2 to 13.2 mm) preoperatively (P < .01). Preoperative anteromedial instability was seen in 71% of patients (15/21), whereas none of the patients had anteromedial rotatory instability at the last follow-up. The mean IKDC subjective score improved overall from 45.3 ± 12.0 (range, 28.7-69.0) preoperatively to 87.7 ± 8.2 (range, 65.5-100.0) at the last follow-up (P < .01). Most patients (20/21) had normal or nearly normal range of motion of the knee joint; only 1 patient (5%) had a limitation of flexion of 15° compared with the contralateral knee at the last follow-up.


CONCLUSIONS
In patients with chronic ACL-MCL lesions, simultaneous reconstruction of the ACL and MCL can significantly improve the medial, sagittal, and rotatory stability of the knee at short-term follow-up.
Department of Sports Medicine and Joint Surgery, The First Affiliated Hospital of China Medical University, Shenyang, China.
Hangzhou
H
Zhang
Department of Sports Medicine and Joint Surgery, The First Affiliated Hospital of China Medical University, Shenyang, China.
Yu
Y
Sun
Department of Sports Medicine and Joint Surgery, The First Affiliated Hospital of China Medical University, Shenyang, China.
Xiaorui
X
Han
Department of Sports Medicine and Joint Surgery, The First Affiliated Hospital of China Medical University, Shenyang, China.
Yanfeng
Y
Wang
Department of Sports Medicine and Joint Surgery, The First Affiliated Hospital of China Medical University, Shenyang, China.
Lin
L
Wang
Department of Sports Medicine and Joint Surgery, The First Affiliated Hospital of China Medical University, Shenyang, China.
Ali
A
Alquhali
Department of Sports Medicine and Joint Surgery, The First Affiliated Hospital of China Medical University, Shenyang, China zpmhh@sina.com.
Xizhuang
X
Bai
D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007593:Joint Instability / Q000601:surgery*; D007718:Knee Injuries / Q000601:surgery*; D007719:Knee Joint / Q000601:surgery*; D008297:Male; D017888:Medial Collateral Ligament, Knee / Q000293:injuries / Q000601:surgery*; D008875:Middle Aged; D016896:Treatment Outcome
ACL-MCL reconstruction; anteromedial rotatory instability; sagittal instability; valgus instability