Purpose
To evaluate differences in repair and nonoperatively managed grade III medial collateral
ligament (MCL) injuries during anterior cruciate ligament (ACL) reconstruction.
Methods
Patients enrolled in a multicenter prospective longitudinal group who underwent unilateral
primary ACL reconstruction between 2002 and 2008 were evaluated. Patients with concomitant
grade III MCL injuries treated either operatively or nonoperatively were identified.
Concurrent injuries, subsequent surgeries, surgical chronicity, and MCL tear location
were analyzed. Patient-reported outcomes were measured at time of ACL reconstruction
and 2-year follow-up.
Results
Initially, 3,028 patients were identified to have undergone primary ACL reconstruction
during the time frame; 2,586 patients completed 2-year follow-up (85%). Grade III
MCL tears were documented in 1.1% (27 of 2,586): 16 operatively managed patients and
11 nonoperatively treated MCLs during ACL reconstruction. The baseline Knee Injury
and Osteoarthritis Outcome Score (KOOS) and International Knee Documentation Committee
scores were lower in patients who underwent operative MCL treatment. Reoperation rates
for arthrofibrosis were 19% after repair and 9% after conservative management (P = .48). At 2 years, both groups significantly improved; however, the nonoperative
MCL group maintained superior patient-reported outcomes in terms of minimal clinically
important differences, but these differences did not reach statistical significance
(KOOS sports/recreation [88.2 vs 74.4, P = .10], KOOS knee-related quality of life [81.3 vs 68.4, P = .13], and International Knee Documentation Committee [87.6 vs 76.0, P = .14]). Tibial-sided MCL injuries were associated with clinically inferior baseline
scores compared with femoral-sided MCL (KOOS knee-related quality of life, 34.4 vs
18.5, P = .09), but these differences resolved by 2 years. Surgical chronicity did not influence
2-year outcome.
Conclusions
Both operative and nonoperative management of MCL tears in our patient group demonstrated
clinical improvements between study enrollment and 2-year follow-up. MCL surgery during
ACL reconstruction was assigned to patients with worse symptoms at enrollment and
was associated with worse outcomes at 2 years. A subset of patients with severe combined
ACL and medial knee injuries may benefit from operative management; however, that
population has yet to be defined.
Level of Evidence
Level III, retrospective cohort.
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Article info
Publication history
Published online: March 13, 2019
Accepted:
October 29,
2018
Received:
July 3,
2018
Footnotes
The authors report the following potential conflicts of interest or sources of funding: K.S. receives grants from NIH/NIAMS; funding for research from Smith & Nephew Endoscopy and DonJoy Orthopaedics; royalty or consulting fees from the NFL, Cytori, and Mitek; and other support from nPhase. L.H. receives grants from NIH/NIAMS and unrestricted educational gifts from Smith & Nephew Endoscopy and DonJoy Orthopaedics. B.W. is a consultant for ConMed. R.B. receives speaker fees from Arthrex and is a consultant for Magellan. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health under Award Number R01AR053684 (K.P.S.) and under Award Number K23AR066133. The content is solely the responsibility of the authors and does not necessarily represent official views of the National Institutes of Health. The project was also supported by the Vanderbilt Sports Medicine Research Fund, which received unrestricted educational gifts from Smith & Nephew Endoscopy and DonJoy Orthopaedics.
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© 2019 by the Arthroscopy Association of North America
