title: Acute MCL and ACL injuries: first results of minimal-invasive MCL ligament bracing with combined ACL single-bundle reconstruction.
abstract: BACKGROUND
  There is an on-going discussion whether to operatively treat combined grade II and III lesions of the medial collateral ligament (MCL) with anterior cruciate ligament (ACL) in the acute phase rather than conservative treatment of the MCL lesion with a delayed unitary ACL replacement. Another issue is the question how to technically address these MCL lesions. The aim of this study was, therefore, to analyze the results of simultaneous ACL replacement (hamstrings) in a single-bundle technique with a simultaneous MCL ligament bracing procedure.
  
  
  METHODS
  In this prospective non-randomized trial,, 16 patients were included with grade II and III lesions of the MCL. Surgical treatment was performed within 14 days (mean 10.4 days, SD ±2.3 days) by one single expert orthopedic surgeon using the semitendinosus tendon and Rigidfix® system for femoral and tibial fixation and 3.5 mm screws with one 1.3 mm PDS Cord for minimal-invasive MCL ligament bracing with screw fixation. Knee stability was measured with the Rolimeter® and KT-1000®. MCL stability was assessed in clinically and radiographically with valgus stress projections.
  
  
  RESULTS
  The mean patient age was 36.4 with six female and ten male patients. There were no surgical complications such as infections or healing disturbances. Mean operation time was 64 ± 6 min. The arthrofibrosis rate was 0 %. Medial knee stability was normal in full extension for all cases with no intra-individual side-to-side difference. Radiological assessed MCL stability revealed Δ values with a mean of 1.1 ± 1.3 mm compared to the contra-lateral side. The Lachman Test revealed a side-to-side difference of 1.6 mm with the KT-1000® and 2.6 ± 0.9 mm when measured with the Rolimeter®. Subjective clinical assessment revealed good results with a mean Lysholm Score of 89.1 points.
  
  
  CONCLUSIONS
  Acute ACL replacement and MCL ligament bracing with this novel technique revealed in this study good clinical results and objective restored knee stability without cases of knee stiffness or arthrofibrosis. The remarkable shortcoming is the small cohort number making further studies necessary.
authors.affiliation: BG Trauma Center Tübingen, Eberhard Karls University, Schnarrenbergstr. 95, 72076, Tübingen, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Ateschrang
authors.affiliation: BG Trauma Center Tübingen, Eberhard Karls University, Schnarrenbergstr. 95, 72076, Tübingen, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Döbele
authors.affiliation: BG Trauma Center Tübingen, Eberhard Karls University, Schnarrenbergstr. 95, 72076, Tübingen, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Freude
authors.affiliation: BG Trauma Center Tübingen, Eberhard Karls University, Schnarrenbergstr. 95, 72076, Tübingen, Germany.
authors.forename: U
authors.initials: U
authors.lastname: Stöckle
authors.affiliation: BG Trauma Center Tübingen, Eberhard Karls University, Schnarrenbergstr. 95, 72076, Tübingen, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Schröter
authors.affiliation: BG Trauma Center Tübingen, Eberhard Karls University, Schnarrenbergstr. 95, 72076, Tübingen, Germany. tkraus@bgu-tuebingen.de.
authors.forename: T M
authors.initials: TM
authors.lastname: Kraus
mesh_terms: D000328:Adult; D000070598:Anterior Cruciate Ligament Injuries / Q000601:surgery; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods*; D001182:Arthroscopy; D001863:Bone Screws; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000601:surgery; D007719:Knee Joint / Q000601:surgery; D008297:Male; D017888:Medial Collateral Ligament, Knee / Q000601:surgery*; D008875:Middle Aged; D009984:Orthopedic Fixation Devices; D011446:Prospective Studies; D013710:Tendons / Q000637:transplantation*
keywords: ACL; Knee instability; Ligament bracing; MCL