Surgical Treatment of Acute Grade III Medial Collateral Ligament Injury Combined With Anterior Cruciate Ligament Injury: Anatomic Ligament Repair Versus Triangular Ligament Reconstruction

Dong, Jin‐Tang; Wang, Xiao Feng; Men, Xiaoqian; Zhu, Junjun; Walker, Garth N.; Zheng, Xiao Zuo; Gao, Jin Bao; Chen, Baicheng; Wang, Fei; Zhang, Yingze; Gao, Shi Jun

doi:10.1016/j.arthro.2014.12.010

Cited by 45 publications

(59 citation statements)

References 30 publications

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“…We speculated that these treatments might ignore the high grade MCL injury that could combine posterior-medial structure damage, especially that the POL plays a secondary structure in resisting external rotational stability [4, 5]. After comparing the anatomic ligament repair (ALR) and TLR in treating grade III MCL injury in earlier stage works, Dong et al found that TLR offered better rotatory stability than ALR at final follow-up [23]. In our study, the TERA significantly decreased from 53.38 ± 6.71° to 27.15 ± 4.92° ( P < .001) which proved the effectiveness of restoring rotational stability.…”

Section: Discussionmentioning

confidence: 99%

An anatomical-like triangular-vector ligament reconstruction for the medial collateral ligament and the posterior oblique ligament injury with single femoral tunnel: a retrospective study

Xu¹,

Kang²,

Zhang³

et al. 2017

J Orthop Surg Res

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BackgroundThe purpose of this study was to evaluate the clinical outcomes of anatomical-like triangular-vector ligament reconstruction (TLR) in treating the combined injury of medial collateral ligament (MCL) and posterior oblique ligament (POL).MethodsDuring July 2013 to May 2014, 26 patients who received anatomical-like TLR were included into this study. All patients received clinical physical examination, imaging examination, and knee joint function score both preoperative and follow-up. The stability of the medial structure of the knee joint was examined by physical examination and imaging evaluation, including excessive knee medial opening (EKMO) and tibial external rotation angle (TERA). The function of the knee was evaluated by the subjective questionnaire, including Lysholm, Tegner, and IKDC score. SPSS software was used for statistics analysis.ResultsThe mean follow-up time exceeds 24 months. Two patients occurred with serious heterotopic ossification, and one patient received revision because of screw breakage. EKMO over the contralateral state at 0° decreased from 9.76 ± 2.76 mm to 2.79 ± 1.02 mm with statistical significance (P < .001) and 10.32 ± 2.75 mm decreased to 3.13 ± 0.85 mm at 30° (P < .001). Meanwhile, TERA significantly decreased from 53.38 ± 6.71° to 27.15 ± 4.92° (P < .001). The postoperative Lysholm, Tegner, and IKDC score were superior to preoperative with statistical significance (P < .001).ConclusionsAnatomical-like TLR can reconstruct the graft to cover the insertions which can regain anatomic form and function with a cramped space. Not only the valgus stability and rotational stability can be restored obviously at follow-up but also the usage of implantation can be reduced, decreasing the incidence rate of allergy and saving costs.

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Section: Discussionmentioning

confidence: 99%

An anatomical-like triangular-vector ligament reconstruction for the medial collateral ligament and the posterior oblique ligament injury with single femoral tunnel: a retrospective study

Xu¹,

Kang²,

Zhang³

et al. 2017

J Orthop Surg Res

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“… 18 and Dong et al . 19 documented a role of primary/delayed repair only in avulsion injuries of cruciate ligaments and have advocated on conclusive evidence of reconstruction having better results in midsubstance tears involving collateral and cruciate ligaments.…”

Section: Resultsmentioning

confidence: 99%

Practice Guidelines for the Management of Multiligamentous Injuries of the Knee

Goyal

Tanwar

Joshi

et al. 2017

IJOO

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Background:Multiligamentous injuries of knee remain a gray area as far as guidelines for management are concerned due to absence of large-scale, prospective controlled trials. This article reviews the recent evidence-based literature and trends in treatment of multiligamentous injuries and establishes the needful protocol, keeping in view the current concepts.Materials and Methods:Two reviewers individually assessed the available data indexed on PubMed and Medline and compiled data on incidence, surgical versus nonsurgical treatment, timing of surgery, and repair versus reconstruction of multiligamentous injury.Results:Evolving trends do not clearly describe treatment, but most studies have shown increasing inclination toward an early, staged/single surgical procedure for multiligamentous injuries involving cruciate and collateral ligaments. Medial complex injuries have shown better results with conservative treatment with surgical reconstruction of concomitant injuries.Conclusion:Multiligamentous injury still remains a gray area due to unavailability of a formal guideline to treatment in the absence of large-scale, blinded prospective controlled trials. Any in multiligamentous injuries any intervention needs to be individualized by the presence of any life- or limb-threatening complication. The risks and guarded prognosis with both surgical and non-surgical modalities of treatment should be explained to patient and relations.

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“…La técnica quirúrgica a utilizar en la lesión del LCM es un tema de debate (8,16,17,21,(33)(34)(35)(36) . La reconstrucción del LCM utilizando injerto autólogo de isquiotibiales ha sido reportada con buenos resultados funcionales en pacientes con lesiones crónicas del LCM.…”

Section: Discussionunclassified

“…En nuestra serie y en concordancia con publicaciones actuales, la reconstrucción de la lesión del LCM y del LCA se realizó en el periodo agudo (35,37) , teniendo en cuenta que el LCM durante el periodo agudo presenta un alto potencial de cicatrización, siendo esta característica utilizada como favorecedora para la integración de la reconstrucción ligamentosa, logrando la estabilidad en valgo en el postoperatorio.…”

Section: Discussionunclassified

Retorno al deporte posterior a una reconstrucción simultánea de ligamento cruzado anterior y ligamento colateral medial de grado III en periodo subagudo

Bertona¹,

Zicaro²,

González-Viescas³

et al. 2018

REACA

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RESUMENIntroducción: las lesiones asociadas del ligamento cruzado anterior (LCA) y del ligamento colateral medial (LCM) corresponden al 20% de la lesiones ligamentosas de la rodilla. El tratamiento conservador del LCM y la reconstrucción quirúrgica del LCA son generalmente recomendados. En deportistas, el tratamiento conservador del LCM puede conducir a inestabilidad medial crónica. El manejo óptimo de deportistas con lesiones combinadas de LCA-LCM continúa siendo controvertido. El objetivo de este trabajo es analizar los resultados funcionales y el nivel deportivo alcanzado en el postoperatorio de una serie de pacientes tratados con reconstrucción simultanea de LCA y LCM con un seguimiento mínimo de 2 años. Material y métodos: un total de 20 atletas con reconstrucciones agudas simultáneas de LCA y LCM de grado III fueron tratados entre marzo de 2006 y enero de 2014. El tiempo mínimo de seguimiento fue de 24 meses. Se evaluaron los resultados funcionales subjetivos (International Knee Documentation Committee -IKDC-, Lysholm), rango de movilidad, estabilidad anteromedial y rotacional (Lachmann, pivot shift, estrés valgo). Se registró la capacidad de retorno al deporte (Tegner) y el nivel alcanzado. ABSTRACT IntroducciónEl ligamento colateral medial (LCM) es la estructura ligamentosa de la rodilla más frecuentemente lesionada (1) . Anatómicamente se diferencia en LCM superficial (LCMs), LCM profundo (LCMp) y ligamento posterior oblicuo (LPO) (2) . Dependiendo del porcentaje de compromiso ligamentoso y la inestabilidad medial de la rodilla, las lesiones del LCM se dividen en los grados I, II y III, correspondiendo las lesiones de grado III a la disrupción completa de las fibras ligamentosas (3) . Las lesiones de grado III están asociadas a otras lesiones ligamentosas en el 80% de los casos. De estas lesiones asociadas, el 95% corresponde a lesiones del ligamento cruzado anterior (LCA) (4) . El mecanismo de lesión implica la carga en valgo de la rodilla, rotación externa o un vector de fuerza combinado que requiere la flexión de la rodilla (5)(6)(7) . El manejo de las lesiones de LCM depende del grado del compromiso ligamentoso. En lesiones asiladas de grado I y II el tratamiento no quirúr-gico, con rehabilitación funcional precoz, es ampliamente aceptado. En lesiones de LCM de grado III, especialmente en asociación con lesión de LCA, el tratamiento es controvertido (8)(9)(10)(11)(12) . Múltiples autores consideran que el tratamiento aislado del LCA en lesiones asociadas de LCA y LCM es suficiente para restaurar la estabilidad de la rodilla (13)(14)(15) . Sin embargo, existe evidencia de que en lesiones asociadas de LCA y LCM de grado III, la reparación aislada del LCA se relaciona con mayor carga mecánica sobre el LCA reconstruido, aumentando el riesgo de falla y de inestabilidad crónica sintomática en valgo de la rodilla (16)(17)(18) . La reconstrucción simultánea de LCA y LCM en lesiones asociadas ha sido descrita con buenos resultados funcionales (8,19,20) . Resultados: todos los pacientes mejoraron significat...

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Surgical Treatment of Acute Grade III Medial Collateral Ligament Injury Combined With Anterior Cruciate Ligament Injury: Anatomic Ligament Repair Versus Triangular Ligament Reconstruction

Cited by 45 publications

References 30 publications

An anatomical-like triangular-vector ligament reconstruction for the medial collateral ligament and the posterior oblique ligament injury with single femoral tunnel: a retrospective study

An anatomical-like triangular-vector ligament reconstruction for the medial collateral ligament and the posterior oblique ligament injury with single femoral tunnel: a retrospective study

Practice Guidelines for the Management of Multiligamentous Injuries of the Knee

Retorno al deporte posterior a una reconstrucción simultánea de ligamento cruzado anterior y ligamento colateral medial de grado III en periodo subagudo

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