title: Surgical Treatment of Acute Grade III Medial Collateral Ligament Injury Combined With Anterior Cruciate Ligament Injury: Anatomic Ligament Repair Versus Triangular Ligament Reconstruction.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the clinical results of medial collateral ligament (MCL) anatomic ligament repair (ALR) and triangular ligament reconstruction (TLR) in treating acute grade III MCL injury with respect to imaging and functional results.
  
  
  METHODS
  Between January 2009 and October 2011, a total of 69 patients with an acute grade III MCL tear combined with an anterior cruciate ligament tear were divided into 2 groups: those who underwent ALR and those who underwent TLR. Single-bundle anterior cruciate ligament reconstruction was also performed in all patients. A radiographic stress-position imaging test was performed to evaluate excessive medial opening of the knee. In addition, the Slocum test was carried out to assess anteromedial rotatory instability before surgery and at follow-up. The subjective symptoms and functional outcomes were evaluated preoperatively and postoperatively with International Knee Documentation Committee (IKDC) assessment.
  
  
  RESULTS
  Sixty-four patients with a mean follow-up period of 34 months were included in the final analysis. The measurement results for medial opening at the last follow-up appointment decreased significantly from the pretreatment measurements and fell within the normal range, without a statistically significant difference between the 2 groups (P > .05). The overall incidence of anteromedial rotatory instability was reduced to 21.9% compared with 62.5% preoperatively. However, the incidence of anteromedial rotatory instability in the TLR group (9.4%) decreased significantly compared with that in the ALR group (34.4%) (P < .05). All patients' IKDC subjective scores significantly improved after surgery. No statistically significant difference was found between the 2 groups at the last follow-up (P > .05). The comparison of IKDC extension and flexion deficit scores between the 2 groups showed no significant differences. Eleven patients in the ALR group and 4 in the TLR group complained of medial knee pain. The comparison between the 2 groups showed no significant difference (P > .05).
  
  
  CONCLUSIONS
  The clinical outcomes of this study showed that no major difference existed in the ALR and TLR groups based on IKDC scores and medial opening evaluations in the short-term. However, TLR offered better rotatory stability than ALR at final follow-up.
  
  
  METHODS
  Level II, lesser-quality randomized controlled trial.
authors.affiliation: Department of Orthopaedic Center, Third Hospital, Hebei Medical University, Shijiazhuang, China.
authors.forename: Jiangtao
authors.initials: J
authors.lastname: Dong
authors.affiliation: Department of Orthopaedic Center, Third Hospital, Hebei Medical University, Shijiazhuang, China.
authors.forename: Xiao Feng
authors.initials: XF
authors.lastname: Wang
authors.affiliation: Department of Orthopaedic Center, Third Hospital, Hebei Medical University, Shijiazhuang, China.
authors.forename: Xiaoqian
authors.initials: X
authors.lastname: Men
authors.affiliation: Department of Orthopaedic Center, Third Hospital, Hebei Medical University, Shijiazhuang, China.
authors.forename: Junjun
authors.initials: J
authors.lastname: Zhu
authors.affiliation: Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A.
authors.forename: Garth N
authors.initials: GN
authors.lastname: Walker
authors.affiliation: Department of Orthopaedic Center, Third Hospital, Hebei Medical University, Shijiazhuang, China.
authors.forename: Xiao Zuo
authors.initials: XZ
authors.lastname: Zheng
authors.affiliation: Department of Orthopaedic Center, Third Hospital, Hebei Medical University, Shijiazhuang, China.
authors.forename: Jin Bao
authors.initials: JB
authors.lastname: Gao
authors.affiliation: Department of Orthopaedic Center, Third Hospital, Hebei Medical University, Shijiazhuang, China.
authors.forename: Baicheng
authors.initials: B
authors.lastname: Chen
authors.affiliation: Department of Orthopaedic Center, Third Hospital, Hebei Medical University, Shijiazhuang, China.
authors.forename: Fei
authors.initials: F
authors.lastname: Wang
authors.affiliation: Department of Orthopaedic Center, Third Hospital, Hebei Medical University, Shijiazhuang, China.
authors.forename: Yingze
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Orthopaedic Center, Third Hospital, Hebei Medical University, Shijiazhuang, China. Electronic address: djtloveyz@outlook.com.
authors.forename: Shi Jun
authors.initials: SJ
authors.lastname: Gao
mesh_terms: D000328:Adult; D000368:Aged; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000209:etiology / Q000601:surgery*; D007718:Knee Injuries / Q000601:surgery*; D008297:Male; D017888:Medial Collateral Ligament, Knee / Q000293:injuries / Q000601:surgery*; D008875:Middle Aged; D016059:Range of Motion, Articular; D019651:Plastic Surgery Procedures / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult