Background

A paucity of data exists to guide surgical management of the medial collateral ligament (MCL)/posteromedial complex (PMC). High-grade PMC injuries are often treated with surgical repair or reconstruction; however, guidelines for choosing one or the other technique remain unclear.

Purpose

To systematically review the literature to determine whether repair or reconstruction of the MCL results in better outcomes.

Methods

Using the PRISMA checklist, a systematic review of the literature retrieved results from MEDLINE, Embase, Cochrane, and PubMed databases from 01/1980-01/2021. Exclusion criteria were age <15, technical/case reports, articular fractures, non-operative treatment, and undifferentiated multiligament results.

Results

The authors found five studies which included both MCL repair and reconstruction results (Group A: 109 repairs, 126 reconstructions). The mean patient age was 31.4 years, and mean follow-up time was 4.02 years (minimum, 2 years). Post-operative Lysholm score means for repair and reconstruction were 88.6 and 82.4, respectively. Two studies reported IKDC subjective scores; the means for repair and reconstruction were 68.3 and 42.3, respectively. There was no statistically significant difference found between reconstruction and repair groups of the MCL for Lysholm, Tegner, KOOS, stress radiographs, subjective or objective IKDC scores, and cases of failures (p>.05). No significant difference of arthrofibrosis rates (p>.05) or failure rates (p>.05) were found between repair and reconstruction groups. Across a broader pool of 32 studies (Group B), including studies which provided MCL repair and reconstruction results, and studies which only included results of MCL repair or reconstruction, post-operative arthrofibrosis was noted in 54 of 498 MCL repairs (10.8%) and 31 of 490 (6.3%) MCL/PMC reconstructions. Arthrofibrosis rates were significantly lower in the reconstruction group vs the repair group ((?2=6.4575, p value= 0.01105).

Conclusion

Post-operative arthrofibrosis appears to be more common after MCL repair than MCL/PMC reconstruction. Improved data would be gained by publication of more results detailing MCL repair and MCL/PMC reconstruction side-by-side.