A Case-Control Study Comparing Bone Bruising and Intra-articular Injuries in Patients Undergoing Anterior Cruciate Ligament Reconstruction With and Without Medial Collateral Ligament Tears

Abstract

Background:Concomitant injuries can occur in patients with combined anterior cruciate ligament (ACL) and medial collateral ligament (MCL) tears; however, no studies have compared these injuries in patients undergoing ACL reconstruction with an MCL tear to those with an intact MCL.Purpose:To compare bone bruising, meniscus tears, and chondral lesions in patients undergoing ACL reconstruction with an MCL tear (cases) to those with an intact MCL (controls).Study Design:Case-control study; Level of evidence, 3.Methods:Thirty-two cases and 352 controls were identified from a prospective registry. Bone bruising was confirmed on magnetic resonance imaging, and meniscus tears and chondral lesions were confirmed arthroscopically. Demographics and concomitant injuries were compared between cases and controls using exact chi-square tests. Multivariate logistic regression was used to calculate odds ratios (ORs) and 95% CIs adjusted for age, sex, body mass index, and mechanism and type of injury.Results:Cases had significantly more contact injuries than controls (58.1% vs 21.3%, P < .0001). The prevalence and odds of bone bruising of the lateral tibial plateau (89.7% vs 84.6%; P = .59; OR, 3.53; 95% CI, 0.45-27.71), lateral femoral condyle (82.8% vs 72.8%; P = .28; OR, 1.94; 95% CI, 0.64-5.88), medial tibial plateau (20.7% vs 31.7%; P = 0.29; OR, 0.53; 95% CI, 0.19-1.53), and medial femoral condyle (6.9% vs 8.3%; P ≥ .999; OR, 1.07; 95% CI, 0.21-5.40) did not differ significantly between cases and controls. The prevalence and odds of lateral meniscus tears (53.3% vs 43%; P = .34; OR, 1.85; 95% CI, 0.76-4.52), medial meniscus tears (31.3% vs 33.5%; P = .85; OR, 0.90; 95% CI, 0.37-2.21), and chondral lesions (16% vs 10.8%; P = .50; OR, 0.70; 95% CI, 0.15-3.21) also did not significantly differ between cases and controls.Conclusion:ACL-MCL injuries were most often due to a contact mechanism, whereas ACL tears without associated MCL injury were more frequently due to a noncontact mechanism. However, there were no significant differences in concomitant injuries in ACL-MCL knees versus ACL knees.

Younger age increases the risk of sustaining multiple concomitant injuries with an ACL rupture

“…The lateral meniscus was injured in 42% of our cohort which is similar to reported values that range from 23% to 59% [23,24,32,41,43]. These data would indicate that the majority of ACL injuries occur in combination with a menisinjury, and meniscal injury is known to be an important risk factor for the development of OA [36].…”

“…This is low in comparison to most other studies that report between 69% and 100% [4,6,8,11,29,43,46,50]. As with the overall frequency of BMLs, the frequency of BMLs in the lateral femur and tibia were lower in this study, 44% and 39%, compared to the majority of studies reporting over 60% for the lateral femur and over 70% for the lateral tibia [4,6,11,23,24,29,43,46,50]. This diference is likely driven by the inclusion of ACL-injured subjects regardless of treatment and age.…”

“…There is a lack of agreement in the literature over which meniscus is more commonly injured. The medial meniscus was injured in 55% of the current study cohort which is high in comparison to reported values between 25% and 47% [4,6,14,17,23,24,32,[41][42][43]46]. One possible explanation is that the inclusion of all ages lead to an increased prevalence of incidental medial meniscus injuries.…”

Risk Factors for Concomitant Collateral Ligament Injuries in Children and Adolescents With Anterior Cruciate Ligament Tears

“…In our study, we found no difference in meniscal injuries between groups; however, chondral injuries were more prevalent in the CLI group compared with the ACL group. Kluczynski et al 20 reported that there was no statistically significant difference between patients with ACL and MCL injuries compared with patients with isolated ACL injuries in the prevalence of lateral meniscus tears (53% vs 43%, respectively; P ¼ .34), medial meniscus tears (31% vs 34%, respectively; P ¼ .85), and chondral lesions (16% vs 11%, respectively; P ¼ .50). Other studies have shown that lateral meniscus tears (18%-80%) are more prevalent than medial meniscus tears (0%-28%) in the presence of ACL and MCL tears.…”

“…These lower rates of CLIs in skeletally immature patients may be attributable to increased ligamentous strength relative to bone compared with that of mature patients. 28 Kluczynski et al, 20 using data from a prospective registry of children and adults undergoing ACL reconstruction, reported a higher rate of contact injuries in patients with combined ACL and MCL tears (58%) compared with patients with isolated ACL tears (21%) ( P < .0001). This difference may be because contact injuries more often deliver a varus or valgus load than noncontact injuries.…”