Summary

The Hughston technique, combined with ACL reconstruction and LET, is as effective as treatment for isolated ACL injuries, making it a cost-effective option for managing combined ACL and MCL injuries.

Abstract

Background

Anterior Cruciate Ligament (ACL) tears combined with medial collateral ligament (MCL) injury has been associated with an increased rate of ACL reconstruction (ACL-R) failure, high-grade Pivot Shift, and lower return to sport (RTS) rate. On the other hand, medial side procedures in the setting of ACL-R are associated with knee stiffness and arthrofibrosis.

Purpose

To compare clinical scores, objective knee laxity, failure, and complication rates, in two different patient groups. A group of patients had a combined ACL and MCL injury grade II with chronic instability and underwent ACL-R associated with Lateral Extra-articular Tenodesis (LET) and the Hughston procedure (Hughston group). The control group was matched patients with isolated ACL lesion without medial instability that underwent ACL reconstruction with LET (control group).

Methods

Patients reported outcomes (PROMs), complications, and reoperations were collected for every group. A clinical evaluation was performed including objective anteroposterior laxity measurement (KT-1000) and pivot shift(PS) quantification. The primary outcomes were ACL revision and ACL-clinical failure, a composite parameter of anteroposterior and rotatory laxity. The Two-Way ANOVA for repeated measures test was performed to assess the between-group differences (p<0.05). Surgical and clinical failure were assessed via the Kaplan-Meier method.

Results

A total of 70 patients (35 per group) were enrolled in the present study at a follow-up of 8.1 ± 2.7 years. All the PROMs significantly improved at the final follow-up with no difference between the two groups (p>0.05). ACL-R revision was performed in 2/35 (5.7%) patients in both groups (p=0.787). Clinical failure was identified in 7/28 (25.0%) patients in the Hughston group and 5/29 (17.2%) in the control group (p=0.588). Reoperation due to knee stiffness was required only in 1/35 patients (2.9%) of the Hughston group.

Conclusion

Due to its simplicity and cost-effectiveness, the Hughston technique should be included in the orthopedic surgeon’s armamentarium for the treatment of moderate anteromedial instability in combined ACL and MCL injury. Moreover, the outcomes and failure rate of the Hughston technique combined with an ACL-R + LET are similar to that of an ACL-R + LET used to treat an isolated ACL injury.