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.

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.

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 Psychological Rehabilitation From Anterior Cruciate Ligament–Medial Collateral Ligament Reconstructive Surgery: A Case Study

2009 ◽  
Vol 2 (1) ◽  
pp. 73-77 ◽  
Author(s):  
Siobhain McArdle
Keyword(s):  
Anterior Cruciate Ligament ◽  
Medial Collateral Ligament ◽  
Cruciate Ligament ◽  
Traumatic Injury ◽  
Situational Factors ◽  
Ligament Injury ◽  
Collateral Ligament ◽  
Retrospective Case ◽  
Psychological Response ◽  
Anterior Cruciate

Background: Research has shown that some of the more common psychological responses to injury (ie, depression, anger, anxiety) are amplified in cases of traumatic injury. Hypothesis/Purpose: An 18-year-old male scholarship soccer player who, owing to a perceived deliberate injurious tackle by an opposition player, tore the medial collateral ligament and anterior cruciate ligament of his right knee. A psychological case perspective is presented. Study Design: Retrospective case report. Results: Various personal and situational factors can compound negative psychological response to injury. A number of extreme responses are explored, including posttraumatic stress, depression, and fear of reinjury. Conclusions: Practitioners should be willing and able to facilitate referral in the instance of more extreme psychological response to anterior cruciate ligament injury.

Results of a New Treatment Concept for Concomitant Lesion of Medial Collateral Ligament in Patients with Rupture of Anterior Cruciate Ligament

2016 ◽  
Vol 30 (07) ◽  
pp. 652-658 ◽  
Author(s):  
Jochen Paul ◽  
Maximilian Haenle ◽  
Jannes Sailer ◽  
Geert Pagenstert ◽  
Lutz Wehren ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Medial Collateral Ligament ◽  
Cruciate Ligament ◽  
Acl Rupture ◽  
Treatment Concept ◽  
Collateral Ligament ◽  
Term Outcome ◽  
Anterior Cruciate ◽  
New Treatment

AbstractAnteromedial knee injury with rupture of anterior cruciate ligament (ACL) and concomitant lesion of medial collateral ligament (MCL) is common in athletes. No standardized treatment concept can be found within the literature. This study presents results of a new treatment concept for concomitant MCL lesions in patients with ACL rupture. In this study, 67 recreational athletes with ACL injury and concomitant MCL lesion were treated according to a distinct treatment concept. Patients were classified in six different types of concomitant MCL lesion depending on grade of MCL lesion and presence of anteromedial rotatory instability (AMRI). Final classification and surgical indication were determined 6 weeks posttraumatic. All patients received ACL reconstruction. MCL was treated by surgical or conservative regime due to type of concomitant MCL lesion. International Knee Documentation Committee (IKDC), AMRI, and Lysholm scores were evaluated both preoperatively and after 6 weeks, 16 weeks, 12 months, and 18 months postoperatively. All patients could be uniquely classified and treated according to the introduced treatment concept. AMRI was verifiable in patients with grade II and III MCL lesions. All patients showed good to excellent clinical results at the follow-up examinations. In all 67 patients (100%), the findings were graded as normal or nearly normal according to the IKDC knee examination form. Lysholm score averaged 93.9 at final follow-up. The introduced treatment concept showed good results on short-term outcome and provides a sufficient treatment strategy for concomitant MCL lesions in athletes with ACL rupture.

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