Does ACL Reconstruction Restore Knee Stability in Combined Lesions?

Abstract

Treating anterior cruciate ligament (ACL) lesions combined with a torn medial collateral ligament (MCL) is controversial because residual laxity may lead to stretching of the ACL graft and eventual failure of the reconstruction. Few studies describe the in vivo translations of combined ACL and MCL injuries. We compared the preoperative and postoperative laxity between patients with combined ACL+MCL Grade II injuries and isolated ACL ruptures and tested whether an ACL reconstruction could restore all laxities in both groups. We evaluated knee kinematics during ACL reconstruction in 57 patients (37 ACL lesions and 20 ACL+MCL injury). Laxity tests were performed before and after graft fixation. Postoperatively, there was greater anteroposterior laxity and greater varus-valgus laxity in the group with MCL injury compared to the group with an ACL lesion only. This finding suggests residual laxities remain when ACL reconstruction is performed in patients with combined ACL+MCL lesion, and raises the question of addressing the MCL ligament when Grade II laxity is found.

Short-term Clinical Importance of Osseous Injuries Diagnosed at MR Imaging in Patients with Anterior Cruciate Ligament Tear

“…Furthermore, some patients with ACL injury had partial-thickness tears of the medial collateral ligament, which may have influenced the postoperative IKCD score. However, previous studies have documented excellent clinical outcomes in patients with ACL reconstruction who had conservatively treated partial-thickness medial collateral ligament tears (39)(40)(41). In addition, our study included only a small number of patients with trabecular fractures and thus did not have the statistical power to investigate the influence of this fracture type on clinical outcome following ACL reconstruction surgery.…”

Surgical Technique: Does Mini-invasive Medial Collateral Ligament and Posterior Oblique Ligament Repair Restore Knee Stability in Combined Chronic Medial and ACL Injuries?

“…Injuries to the posterior oblique ligament (POL) are associated with Grade III medial injuries [19] with resulting valgus and rotatory instability [4]. Residual laxities remain when surgeons perform ACL reconstruction in patients with combined ACL and medial instability, raising the questions of whether and how to repair the medial capsular and ligament structures in the presence of Grade II to III medial laxity [34]. Medial laxity implies a larger load on the ACL in chronic anteromedial instability [7].…”

La chirurgia computer-assisitita nella ricostruzione del LCA

“…Ci siamo chiesti se fosse possibile identificare una lassità residua in pazienti con lesione combinate di LCA e legamento collaterale mediale (LCM), confrontandoli con quelli con lesione singola del LCA [6]. I pazienti sono stati prospetticamente classificati in due gruppi: i pazienti con lesione isolata del LCA sono stati usati come gruppo di controllo (Gruppo I) e i pazienti con una lesione di grado II del legamento collaterale mediale combinato con lesione dell'LCA sono stati usati come gruppo di studio (Gruppo II).…”