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Ultrasound-based evaluation revealed reliable postoperative knee stability after combined acute ACL and MCL injuries
PURPOSE: Anterior cruciate ligament (ACL) injuries are often combined with lesions of the medial collateral ligament (MCL). The aim of this study was to evaluate treatment outcome of combined acute ACL and MCL lesions using functional US and clinical examination. METHODS: Patients aged > 18 years...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer Berlin Heidelberg
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8443730/ https://www.ncbi.nlm.nih.gov/pubmed/34524557 http://dx.doi.org/10.1186/s40634-021-00401-7 |
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author | Lutz, Patricia M. Höher, Louisa S. Feucht, Matthias J. Neumann, Jan Junker, Daniela Wörtler, Klaus Imhoff, Andreas B. Achtnich, Andrea |
author_facet | Lutz, Patricia M. Höher, Louisa S. Feucht, Matthias J. Neumann, Jan Junker, Daniela Wörtler, Klaus Imhoff, Andreas B. Achtnich, Andrea |
author_sort | Lutz, Patricia M. |
collection | PubMed |
description | PURPOSE: Anterior cruciate ligament (ACL) injuries are often combined with lesions of the medial collateral ligament (MCL). The aim of this study was to evaluate treatment outcome of combined acute ACL and MCL lesions using functional US and clinical examination. METHODS: Patients aged > 18 years undergoing primary ACL reconstruction with concomitant operative (group 1) or non-operative treatment of the MCL (group 2) between 2014 and 2019 were included after a minimum follow-up of 12 months. Grade II MCL injuries with dislocated tibial or femoral avulsions and grade III MCL ruptures underwent ligament repair whereas grade II injuries without dislocated avulsions were treated non-operatively. Radiological outcome was assessed with functional US examinations. Medial knee joint width was determined in a supine position at 0° and 30° of knee flexion in unloaded and standardized loaded (= 15 Dekanewton) conditions using a fixation device. Clinical examination was performed and patient-reported outcomes were assessed by the use of the subjective knee form (IKDC), Lysholm score, and the Tegner activity scale. RESULTS: A total of 40 patients (20 per group) met inclusion criteria. Mean age of group 1 was 40 ± 12 years (60% female) with a mean follow-up of 33 ± 17 months. Group 2 showed a mean age of 33 ± 8 years (20% female) with a mean follow-up of 34 ± 15 months. Side-to-side differences in US examinations were 0.4 ± 1.5 mm (mm) in 0° and 0.4 ± 1.5 mm in 30° knee flexion in group 1, and 0.9 ± 1.1 mm in 0° and 0.5 ± 1.4 mm in 30° knee flexion in group 2, with no statistically significant differences between both groups. MCL repair resulted in lower Lysholm scores (75 ± 19 versus 86 ± 15; p < 0.05). No significant differences could be found for subjective IKDC or Tegner activity scores among the two groups. CONCLUSION: A differentiated treatment concept in combined ACL and MCL injuries based on injury patterns leads to reliable postoperative ligamentous knee stability in US-based and clinical examinations. However, grade II and III MCL lesions with subsequent operative MCL repair (group 1) result in slightly poorer subjective outcome scores. LEVEL OF EVIDENCE: Retrospective cohort study; Level III |
format | Online Article Text |
id | pubmed-8443730 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Springer Berlin Heidelberg |
record_format | MEDLINE/PubMed |
spelling | pubmed-84437302021-10-01 Ultrasound-based evaluation revealed reliable postoperative knee stability after combined acute ACL and MCL injuries Lutz, Patricia M. Höher, Louisa S. Feucht, Matthias J. Neumann, Jan Junker, Daniela Wörtler, Klaus Imhoff, Andreas B. Achtnich, Andrea J Exp Orthop Original Paper PURPOSE: Anterior cruciate ligament (ACL) injuries are often combined with lesions of the medial collateral ligament (MCL). The aim of this study was to evaluate treatment outcome of combined acute ACL and MCL lesions using functional US and clinical examination. METHODS: Patients aged > 18 years undergoing primary ACL reconstruction with concomitant operative (group 1) or non-operative treatment of the MCL (group 2) between 2014 and 2019 were included after a minimum follow-up of 12 months. Grade II MCL injuries with dislocated tibial or femoral avulsions and grade III MCL ruptures underwent ligament repair whereas grade II injuries without dislocated avulsions were treated non-operatively. Radiological outcome was assessed with functional US examinations. Medial knee joint width was determined in a supine position at 0° and 30° of knee flexion in unloaded and standardized loaded (= 15 Dekanewton) conditions using a fixation device. Clinical examination was performed and patient-reported outcomes were assessed by the use of the subjective knee form (IKDC), Lysholm score, and the Tegner activity scale. RESULTS: A total of 40 patients (20 per group) met inclusion criteria. Mean age of group 1 was 40 ± 12 years (60% female) with a mean follow-up of 33 ± 17 months. Group 2 showed a mean age of 33 ± 8 years (20% female) with a mean follow-up of 34 ± 15 months. Side-to-side differences in US examinations were 0.4 ± 1.5 mm (mm) in 0° and 0.4 ± 1.5 mm in 30° knee flexion in group 1, and 0.9 ± 1.1 mm in 0° and 0.5 ± 1.4 mm in 30° knee flexion in group 2, with no statistically significant differences between both groups. MCL repair resulted in lower Lysholm scores (75 ± 19 versus 86 ± 15; p < 0.05). No significant differences could be found for subjective IKDC or Tegner activity scores among the two groups. CONCLUSION: A differentiated treatment concept in combined ACL and MCL injuries based on injury patterns leads to reliable postoperative ligamentous knee stability in US-based and clinical examinations. However, grade II and III MCL lesions with subsequent operative MCL repair (group 1) result in slightly poorer subjective outcome scores. LEVEL OF EVIDENCE: Retrospective cohort study; Level III Springer Berlin Heidelberg 2021-09-15 /pmc/articles/PMC8443730/ /pubmed/34524557 http://dx.doi.org/10.1186/s40634-021-00401-7 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . |
spellingShingle | Original Paper Lutz, Patricia M. Höher, Louisa S. Feucht, Matthias J. Neumann, Jan Junker, Daniela Wörtler, Klaus Imhoff, Andreas B. Achtnich, Andrea Ultrasound-based evaluation revealed reliable postoperative knee stability after combined acute ACL and MCL injuries |
title | Ultrasound-based evaluation revealed reliable postoperative knee stability after combined acute ACL and MCL injuries |
title_full | Ultrasound-based evaluation revealed reliable postoperative knee stability after combined acute ACL and MCL injuries |
title_fullStr | Ultrasound-based evaluation revealed reliable postoperative knee stability after combined acute ACL and MCL injuries |
title_full_unstemmed | Ultrasound-based evaluation revealed reliable postoperative knee stability after combined acute ACL and MCL injuries |
title_short | Ultrasound-based evaluation revealed reliable postoperative knee stability after combined acute ACL and MCL injuries |
title_sort | ultrasound-based evaluation revealed reliable postoperative knee stability after combined acute acl and mcl injuries |
topic | Original Paper |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8443730/ https://www.ncbi.nlm.nih.gov/pubmed/34524557 http://dx.doi.org/10.1186/s40634-021-00401-7 |
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