2021 ISAKOS Biennial Congress ePoster
“Intraoperative assessment of residual medial laxity immediately after ACLR aids In decision for Management of grade 3 Mcl Tear in Combined Injury?”
Silvampatti Ramasamy Sundararajan, MS(Orth), COIMBATORE, TAMILNADU INDIA
Rajagopalakrishnan Ramakanth, D.ortho, DNB(ortho), D.SICOT, Coimbatore, Tamil Nadu INDIA
S Rajasekaran, MS(Orth),DOrth,DNB,FRCS(Ed),FRCS(Lon),MCh(Liv),PhD, Coimbatore, Tamil Nadu INDIA
Ganga medical centre and hospitals, COIMBATORE, Tamil Nadu, INDIA
FDA Status Not Applicable
Summary
Intra-operative assessment of residual medial side laxity immediately after ACLR aids in decision making for MCL management. Non-operative femur side MCL injury and operated tibial side MCL injury had better result than non-operative tibial side MCL.
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Abstract
Background
The decision for management of (grade III) MCL injuries in combined ACL and MCL injuries is still controversial where few surgeons advocated acute repair while others recommend delayed reconstruction. Further, ACL reconstruction alone would provide some medial side stability by reduced medial opening needs to be assessed and determined.
Purpose
Is to determine whether the intraoperative assessment of residual medial side laxity immediately after ACL reconstruction (ACLR) necessitating the need for MCL repair and to evaluate the outcome of non-operative and operative management for grade 3 MCL injury.
Study design: Retrospective case series (Level IV)
Methods
This is a retrospective study, included acutely presented ACL-MCL(Grade-3) (n=60) patients during January 2016 - December 2018. All underwent ACLR and intraoperatively, valgus stress assessment done, when medial opening <10mm MCL treated non-operatively and opening >10mm MCL repaired. Patients, divided into- Group 1- MCL treated non-operatively (40 patients) and Group 2- MCL repaired (20 patients). Preoperatively clinical assessment, x-rays& MRI evaluation done to assess level of MCL injury. At follow-up, Clinical scores (IKDC and Lyshoms score) and radiographic stress x-ray taken to see antero-posterior laxity and medial laxity at 0 and 30degree.
Results
60 patients with mean follow-up 27.2 month (24-34months) and mean age (group1-38.7yrs & group 2-31.2yrs) and sex M: F (group 1-30:10 & group 2- 16:4). Group 2 had higher IKDC score than group 1 patients (mean 87.5 vs 85.35, p= 0.63) and lower Lysholm score (mean 89.1 vs 86.1, p=0.16). Operatively managed tibial side injured MCL group had statistically higher functional score (p= 0.05 IKDC and p=0.02 LS score) while non-operatively managed femoral side MCL injury had significant higher functional score (p=0.05 IKDC, p= 0.09 LS-score). In stress x-ray medial opening is significantly lower in repaired MCL(p=0.05). Post-operative ROM was lower in operated group than conservative group (p=0.16). Total 6 patient (30%) had knee stiffness in operated group and 2 patients (5%) in conservative group.
Conclusion
Intra-operative assessment of residual medial side laxity immediately after ACLR aids in decision making for MCL management. Non-operative femur side MCL injury and operated tibial side MCL injury had better result than non-operative tibial side MCL.