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

  • Bertona A
  • Zicaro J
  • Viescas J
  • et al.
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Abstract

Introduction: 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 results and the rate of return to sports of patients who underwent combined ACL-MCL surgery 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 (International Knee Documentation Committee –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. In the group of competitive athletes, 66% achieved the sports level prior to injury. 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. Level of evidence: IV, case series. Clinical relevance: there is limited information on the management of associated ACL/MCL grade 3 injuries in athletes. The results of this series of cases are a contribution to the literature. The management of this type of associated injuries in athletes continuing being a controversial point in the literature.

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Bertona, A., Zicaro, J. P., Viescas, J. M. G., Atala, N., Yacuzzi, C., & Costa-Paz, M. (2017). Return to Sports after Acute Simultaneous Reconstruction of Anterior Cruciate Ligament Injury and Grade III Medial Collateral Ligament Injury. Orthopaedic Journal of Sports Medicine, 5(1_suppl), 2325967117S0003. https://doi.org/10.1177/2325967117s00031

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