Purpose
To compare patient-reported outcomes and complications in patients with medial collateral
ligament (MCL) injuries undergoing repair versus reconstruction with a minimum 2-year
follow-up.
Methods
A literature search was conducted using the PubMed, Scopus, and Embase-computerized
databases from database inception to November 2022, according to the 2020 Preferred
Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies
evaluating clinical outcomes and complications at a minimum of 2 years following MCL
repair versus reconstruction were included. Study quality was assessed using the MINORS
criteria.
Results
A total of 18 studies published from 1997 to 2022, consisting of 503 patients were
identified. Twelve studies (n = 308 patients; mean age: 32.6 years) reported outcomes
following MCL reconstruction, and 8 studies (n = 195 patients; mean age: 28.5 years)
reported results following MCL repair. Postoperative International Knee Documentation
Committee, Lysholm, and Tegner scores ranged from 67.6 to 91, 75.8 to 94.8, and 4.4
to 8, respectively, in the MCL reconstruction group, compared to 73 to 91, 75.1 to
98.5, and 5.2 to 10, respectively, in the MCL repair group. Knee stiffness was the
most commonly reported complication following MCL repair (range: 0% - 50%) and reconstruction
(range: 0% - 26.7%). Failures occurred in 0% to 14.6% of patients following reconstruction
versus 0% to 35.1% of patients undergoing MCL repair. Manipulation under anesthesia
(MUA) for postoperative arthrofibrosis (range: 0% - 12.2%) and surgical debridement
for arthrofibrosis (range: 0% - 20%) were the most commonly reported reoperations
in the MCL reconstruction and repair groups, respectively.
Conclusion
MCL reconstruction versus repair both demonstrate improved International Knee Documentation
Committee, Lysholm, and Tegner scores. MCL repair demonstrates higher rates of postoperative
knee stiffness and failure at a minimum 2-year follow-up.
Level of Evidence
Level IV, systematic review of Level III and IV studies.
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References
- Midterm outcomes following acute repair of grade III distal MCL avulsions in multiligamentous knee injuries.J Knee Surg. 2020; 33: 785-791
- Long-term results of conservatively treated medial collateral ligament injuries of the knee joint.Clin Orthop Rel Res. 1988; 226: 103-112
- Treatment of isolated medial collateral ligament injuries in athletes with early functional rehabilitation: A five-year follow-up study.Am J Sports Med. 1994; 22: 470-477
- Treatment of medial and posteromedial knee instability: Indications, techniques, and review of the results.Iowa Orthop J. 2012; 32: 173-183
- Acute treatment of medial collateral ligament tears: Short to mid-term results.J Biol Regul Homeost Agents. 2019; 33 (XIX Congresso Nazionale S.I.C.O.O.P. Societa' Italiana Chirurghi Ortopedici Dell'ospedalita' Privata Accreditata): 203-209
- Single-row repair in chronic medial collateral ligament insufficiency.Arthrosc Tech. 2021; 10: e2027-e2032
- Tibial meniscal dynamics using three-dimensional reconstruction of magnetic resonance images.Am J Sports Med. 1991; 19 (; discussion 215-216): 210-215
- Surgical technique: Development of an anatomic medial knee reconstruction.Clin Orthop Relat Res. 2012; 470: 806-814
- Minimally invasive reconstruction of the medial collateral ligament of the knee.Arch Bone Jt Surg. 2022; 10: 507-513
- Anatomical reconstruction of the medial collateral ligament and posteromedial corner of the knee in patients with chronic medial collateral ligament instability.Am J Sports Med. 2009; 37: 1116-1122
- Comparative outcomes occur after superficial medial collateral ligament augmented repair vs reconstruction: A prospective multicenter randomized controlled equivalence trial.Am J Sports Med. 2022; 50: 968-976
- Lower failure rates and improved patient outcome due to reconstruction of the MCL and revision ACL reconstruction in chronic medial knee instability.Orthop J Sports Med. 2021; 92325967121989312
Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ 372:n71.
- Short- to mid-term outcomes of anatomic MCL reconstruction with Achilles tendon allograft after multiligament knee injury.Knee Surg Sports Traumatol Arthrosc. 2018; 26: 2952-2959
- Combined reconstruction of the posterior cruciate ligament and medial collateral ligament using a single femoral tunnel.Knee Surg Sports Traumatol Arthrosc. 2017; 25: 3024-3030
- Comparative study of superficial medial collateral ligament reconstruction combined with posterior oblique ligament reconstruction or posteromedial capsule advance in grade III injuries of the medial compartment in a complex knee injury scenario.Knee. 2022; 39: 71-77
- Methodological index for non-randomized studies (MINORS): Development and validation of a new instrument.ANZ J Surg. 2003; 73: 712-716
- Patient-reported outcomes after multiligament knee injury: MCL repair versus reconstruction.Orthop J Sports Med. 2017; 52325967117694818
- Outcomes at a minimum of 2 years after medial collateral ligament reconstruction using partial-thickness quadriceps tendon–bone autograft.Orthopedics. 2017; 40: e557-e562
- Concomitant reconstruction of the medial collateral and posterior oblique ligaments for medial instability of the knee.J Bone Jt Surg Br. 2008; 90-B: 1323-1327
- A novel medial collateral ligament reconstruction procedure using semitendinosus tendon autograft in patients with multiligamentous knee injuries: Clinical outcomes.Am J Sports Med. 2013; 41: 1274-1281
- Surgical treatment of subacute and chronic valgus instability in multiligament-injured knees with superficial medial collateral ligament reconstruction using Achilles allografts: A quantitative analysis with a minimum 2-year follow-up.Am J Sports Med. 2013; 41: 1044-1050
- Surgical technique: Medial collateral ligament reconstruction using Achilles allograft for combined knee ligament injury.Clin Orthop Relat Res. 2012; 470: 798-805
- Simultaneous reconstruction of the anterior cruciate ligament and medial collateral ligament in patients with chronic ACL-MCL lesions: A minimum 2-year follow-up study.Am J Sports Med. 2014; 42: 1675-1681
- Ten-year prognosis of isolated and combined medial collateral ligament ruptures: A matched comparison in 40 patients using clinical and radiographic evaluations.Am J Sports Med. 1997; 25: 2-6
- Clinical outcome of primary medial collateral ligament-posteromedial corner repair with or without staged anterior cruciate ligament reconstruction.Injury. 2017; 48: 1236-1242
- Simultaneous surgical management of chronic grade-2 valgus instability of the knee and anterior cruciate ligament deficiency in athletes.Knee Surg Sports Traumatol Arthrosc. 2010; 18: 312-316
- The management of medial ligament tears in patients with combined anterior cruciate and medial ligament lesions.Int Orthop SICOT. 2000; 24: 108-111
- Isolated medial collateral ligament tears.Effort Open Rev. 2018; 3: 398-407
- Primary repair of the medial collateral ligament with internal bracing.Arthrosc Tech. 2017; 6: e933-e937
- Suture tape augmentation improves laxity of MCL repair in the ACL reconstructed knee.Knee Surg Sports Traumatol Arthrosc. 2021; 29: 2545-2552
- Suture tape augmentation of anterior cruciate ligament reconstruction increases biomechanical stability: A scoping review of biomechanical, animal, and clinical studies.Arthroscopy. 2022; 38: 2073-2089
- Medial collateral ligament injury of the knee: A review on current concept and management.Arch Bone Jt Surg. 2021; : 255-262
Article info
Publication history
Published online: March 07, 2023
Accepted:
March 2,
2023
Received:
January 30,
2023
Publication stage
In Press Journal Pre-ProofFootnotes
The authors report no conflicts of interest in the authorship and publication of this article. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Identification
Copyright
© 2023 by the Arthroscopy Association of North America
