Simultaneous Reconstruction of the Anterior Cruciate Ligament and Medial Collateral Ligament in Patients With Chronic ACL-MCL Lesions

2014 ◽  
Vol 42 (7) ◽  
pp. 1675-1681 ◽  
Author(s):  
Hangzhou Zhang ◽  
Yu Sun ◽  
Xiaorui Han ◽  
Yanfeng Wang ◽  
Lin Wang ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Medial Collateral Ligament ◽  
Cruciate Ligament ◽  
Collateral Ligament ◽  
Simultaneous Reconstruction ◽  
Anterior Cruciate

scholarly journals Simultaneous reconstruction of anterior cruciate ligament (ACL) with autologous graft and of medial collateral ligament (MCL) with allograft

2014 ◽  
Vol 2 (12_suppl4) ◽  
pp. 2325967114S0024
Author(s):  
José Luis Aparicio ◽  
Lisandro Nardin ◽  
Matías S. Savá
Keyword(s):  
Anterior Cruciate Ligament ◽  
Surgical Technique ◽  
Medial Collateral Ligament ◽  
Cruciate Ligament ◽  
Anatomical Reconstruction ◽  
Collateral Ligament ◽  
Autologous Graft ◽  
Simultaneous Reconstruction ◽  
Titanium Screws ◽  
Anterior Cruciate

Introduction: Over the last years, the incidence of multiple ligament injuries has increased significantly due to the rising number of traffic accidents in relation to their kinetics and due to higher sports demands. Among their various combinations, one of them is the lesion of anterior cruciate ligament (ACL) which is associated to medial collateral ligament responsible for them in a 13 %. Nowadays several techniques to the reconstruction of Anterior Cruciate Ligament (ACL) and Medial Collateral Ligament (MCL) are applied. Therefore, for the last three years, we have carried out the simultaneous reconstruction of ACL with autologous graft and of MCL with allograft. Benefits include avoidance of morbidity in multiple donor areas, a safe bone-to-bone fixation in the case of Achilles tendon grafting; tiny incisions in the skin , and anatomical reconstruction. Throughout the years, the use of allografts has been very frequent. This is due to their safety factors, accessibility and their functional outcomes in the long term. Objectives: Show our surgical technique and experience in the combined reconstruction of anterior cruciate ligament with autologous graft and of medial collateral ligament with allograft. Methods: Fourteen (14) patients, with an average age of 29, were evaluated after they had undergone a reconstruction of ACL and MCL with autologous graft and allograft respectively. Average follow-up was 19.6 months. With respect to the surgical technique, it comprises two small incisions placing the anatomical femoral and tibial insertion for the MCL, and arthroscopically the anatomical location of the LCA. Later, some corresponding holes are made to be fixed with blunt Titanium screws following the same procedure. Mobility, joint laxity and subjective functionality were evaluated by means of Lysholm scores and International Knee Documentation Committee (IKDC). Results: The Average Lysholm knee score was 93, while all the patients were classified A/B according to the IKDC and were able to return to their normal sport and daily activity. Their range of motion remained stable. Conclusion: In multiple ligament knee injury, the use of allografts or in combination with autologous graft has become a valid resource. The lower risk of morbidity from the donor zone, the lower exposure of tissues, the lower postoperative pain with the MCL allograft at a low cost and greater security with ACL autologous graft have turned this surgical technique in a viable option for multi-ligament injured knee reconstruction.

scholarly journals Return to Sports after Acute Simultaneous Reconstruction of Anterior Cruciate Ligament Injury and Grade III Medial Collateral Ligament Injury

2017 ◽  
Vol 5 (1_suppl) ◽  
pp. 2325967117S0003
Author(s):  
Agustin Bertona ◽  
Juan Pablo Zicaro ◽  
Juan Manuel Gonzalez Viescas ◽  
Nicolas Atala ◽  
Carlos Yacuzzi ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Medial Collateral Ligament ◽  
Cruciate Ligament ◽  
Return To Sport ◽  
Ligament Injury ◽  
Collateral Ligament ◽  
Simultaneous Reconstruction ◽  
Anterior Cruciate ◽  
Grade Iii

Objectives: Combined Anterior Cruciate Ligament (ACL) injury and Medial Collateral Ligament (MCL) injury account for 20% of knee ligament lesions. Conservative treatment of MCL and surgical ACL reconstruction are generally recommended. Significant medial instability after non-surgical management of MCL can lead to ACL reconstruction failure. The optimal management for athletes with combined ACL-MCL injuries remains controversial. The purpose of this study was to analyze the functional and clinical evolution of patients who underwent combined ACL-MCL surgery and their return-to-sport level with minimum 2-years follow-up. Methods: A total of 20 athletes with acute simultaneous ACL/Grade III MCL reconstructions were treated between March 2006 and January 2014. The minimum follow-up time was 24 months. Subjective functional results (IKDC, Lysholm), range of motion, anterior-medial and rotational stability (Lachmann, Pivot Shift, valgus stress) were evaluated. The ability to return to sport (Tegner) and the level achieved was recorded. Results: All patients significantly improved functional scores and stability tests. The mean subjective IKDC score improved from 37.7 ± 12.9 (range 21-69) preoperatively to 88.21 ± 4.47 (range 80-96) postoperatively (P <0.05). The average Lysholm score was 40.44 ± 10.58 (range 27-65) preoperatively and 90.83 ± 3.38 (range 84-95) postoperatively (P <0.05). Valgus and sagittal laxity was not observed (IKDC A 92% B 8%) at final follow-up. All patients had normal/nearly normal (IKDC A or B) mobility. All patients returned to sports; 90% reached the level they had prior to the ligamentous injury. Of all competitive athletes, 66% achieved the same level of sport. Conclusion: In athletes with acute ACL-Grade III MCL lesions, an early simultaneous reconstruction can significantly improve the medial and sagittal stability of the knee. This procedure resulted in excellent functional outcomes, with return to the same level of sports in the majority of patients at short-term follow-up.

scholarly journals Simultaneous Reconstruction of Anterior Cruciate Ligament with Autologous Tendon Grafts and Medial Collateral Ligament with Allograft

2018 ◽  
Vol 6 (12_suppl5) ◽  
pp. 2325967118S0018
Author(s):  
Lisandro Nardin ◽  
Matías Savá ◽  
Oscar Calvet ◽  
Fernando Mercier ◽  
Abel Barck ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Surgical Technique ◽  
Medial Collateral Ligament ◽  
Low Cost ◽  
Cruciate Ligament ◽  
Functional Results ◽  
International Knee Documentation Committee ◽  
Collateral Ligament ◽  
Simultaneous Reconstruction ◽  
Anterior Cruciate

Objectives: Our objective is to show our surgical technique and experience in the combined reconstruction of ACL with autograft (either BTB or STGT) and MCL with allograft. (Aquiles Tendon) Methods: Twenty eight (28) patients, with an average age of 29,5, to whom an ACL and an MCL reconstruction with auto graft and allogeneic graft respectively was performed. These patients experienced residual internal instability after conservative treatment. Average follow-up was 19.6 months. Range of motion, joint laxity and subjective functionality were evaluated whit Lysholm scores and International Knee Documentation Committee (IKDC). Results: The Average Lysholm knee score was 93, while all the patients were classified A/B according to the IKDC and were able to return to their normal sport and daily activity. Conclusion: Nowadays various reconstructive techniques of anterior cruciate ligament (ACL) and of medial collateral ligament (MCL) are being utilized. Over the years the use of allografts have become common due to their safety, accesibility and satisfactory functional results. In multi-ligament injuries the single use of allografts or in combination with autologous grafts have become a valid resource. The lower risk of morbidity from the donor zone, the lower exposure of tissues, the lower postoperative pain with the MCL allogeneic graft at a low cost and greater security with ACL autologous graft have turned this surgical technique in a viable option for multi-ligament injured knee reconstruction.

scholarly journals IS PERCUTANEOUS MEDIAL COLLATERAL LIGAMENT (MCL) RELAXATION DURING ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION A SAFE OPTION FOR GAINING ACCESS TO THE MEDIAL KNEE COMPARTMENT IN CHILDREN?

2021 ◽  
Vol 9 (7_suppl3) ◽  
pp. 2325967121S0004
Author(s):  
John A. Schlechter ◽  
Tanner Harrah ◽  
Bryn Gornick ◽  
Benjamin Sherman
Keyword(s):  
Anterior Cruciate Ligament ◽  
Children And Adolescents ◽  
Medial Collateral Ligament ◽  
Cruciate Ligament ◽  
Adult Population ◽  
Deep Infection ◽  
Patient Reported Outcome ◽  
Collateral Ligament ◽  
Patient Reported ◽  
Anterior Cruciate

Introduction: With participation in youth sports anterior cruciate ligament (ACL) injuries are a common occurrence. Nearly 70% of ACL tears in children and adolescents have an associated meniscus tear. Percutaneous medial collateral ligament (MCL) relaxation has been described as utilitarian in accessing the medial meniscus for diagnostic assessment and treatment in the adult population to increase medial compartment working space in arthroscopic surgery. The technique has not been evaluated in the pediatric population. The purpose of this study was to compare the outcomes of children and adolescents that underwent anterior cruciate ligament reconstruction (ACLR) with and without percutaneous relaxation of the medial collateral ligament (MCL) for meniscal tear management. Methods: A retrospective review was performed of patients aged 8 to 19 years old that had undergone knee arthroscopy for an (ACLR) with meniscus pathology. Those that underwent MCL relaxation were grouped together and compared to a matched cohort that did not have MCL relaxation performed. Preoperative, operative and postoperative data was analyzed. The primary measurement was obtained using a validated patient reported outcome score (Pedi-IKDC), secondary outcome measures were defined as superficial or deep infection, saphenous nerve dysesthesias, ACL graft failure and return to the operating room. Statistical analysis of the two cohorts was performed. Results: Fifty-four patients were included in the study (27 in each group) with average age 15 years (range 10-19). Average follow-up for the MCL relaxation group was 22.4 months versus 58 months for the non-MCL relaxation group. The average Pedi-IKDC score was 93.3 for the MCL relaxation group and 91.4 for the non-MCL relaxation group (p=0.34). There was no difference in patient demographics, return to the operating room (p=0.49), saphenous nerve dysesthesia (p=0.49), superficial or deep infection (p=0.32). Conclusion: ACL reconstruction in children and adolescents with MCL relaxation for the management of medial meniscal tears appears to be a safe option. Equivocal patient reported outcome scores as compared to the control group were found with no increase in post-operative complications. In children with ACL tears, appropriate diagnosis and management of medial meniscal pathology is important to maintain secondary restraint to anterior tibial translation and prevent premature graft failure. Pediatric knees can have tight medial compartments, making access difficult, potentially leading to poor visualization and iatrogenic chondral damage. Percutaneous medial collateral ligament (MCL) relaxation has been described in the adult population to increase medial compartment working space without long term sequela. We report similar findings in an all pediatric cohort.

Acute Grade III Medial Collateral Ligament Injury of the Knee Associated with Anterior Cruciate Ligament Tear: The Usefulness of Magnetic Resonance Imaging in Determining a Treatment Regimen

2003 ◽  
Vol 31 (2) ◽  
pp. 261-267 ◽  
Author(s):  
Norimasa Nakamura ◽  
Shuji Horibe ◽  
Yukiyoshi Toritsuka ◽  
Tomoki Mitsuoka ◽  
Hideki Yoshikawa ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Medial Collateral Ligament ◽  
Cruciate Ligament ◽  
Superficial Layer ◽  
Ligament Injury ◽  
Resonance Imaging ◽  
Collateral Ligament ◽  
Medial Collateral Ligament Injury ◽  
Anterior Cruciate ◽  
Grade Iii

Background: The appropriate management of acute grade III medial collateral ligament injury when it is combined with a torn anterior cruciate ligament has not been determined. Hypothesis: Magnetic resonance imaging grading of grade III medial collateral ligament injury in patients who also have anterior cruciate ligament injury correlates with the outcome of their nonoperative treatment. Study Design: Prospective cohort study. Methods: Seventeen patients were first treated nonoperatively with bracing. Eleven patients with restored valgus stability received anterior cruciate ligament reconstruction only, and six with residual valgus laxity also received medial collateral ligament surgery. Results: Magnetic resonance imaging depicted complete disruption of the superficial layer of the medial collateral ligament in all 17 patients and disruption of the deep layer in 14. Restoration of valgus stability was significantly correlated with the location of superficial fiber damage. Damage was evident over the whole length of the superficial layer in five patients, and all five patients had residual valgus laxity despite bracing. Both groups had good-to-excellent results 5 years later. Conclusions: Location of injury in the superficial layer may be useful in predicting the outcome of nonoperative treatment for acute grade III medial collateral ligament lesions combined with anterior cruciate ligament injury.

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