Summary: Currently, there is no guidelines on how to select the patients for MCL operative and non-operative management. Management of MCL in KD3M injuries is still contentious. Aim is to compare outcomes of both groups. In conclusion MCL operated patients showed better restoration of medial laxity. Mid substance tear showed significant medial laxity in-spite of repair and needs augmentation techniques.

Background

KD3M type denotes all knee dislocations(KD) with ACL, PCL tears with medial sided injury. MCL femoral tear has good healing potential and can be treated non-operatively in acute stages. Mid-substance and tibial sided MCL tears have lower healing potential, necessitate repair or reconstruction surgeries. Currently, there is no guidelines on how to select the patients for MCL operative and non-operative management. Management of MCL by operative versus non-operative management in KD3M injuries is still contentious. The aim of this study is to compare the outcomes of both groups with single stage ACL and PCL reconstruction.

Methods

All consecutive KD3M type of Multi-Ligament Knee Injuries(MLKI) patients in tertiary Level 1 trauma center between 2012-2022 who underwent ACL and PCL reconstruction within 3 weeks of injury were enrolled. Other KD’s type MLKIs(KD2, KD3L, KD4, KD5) injuries, open injuries and arthritic knees were excluded. In total, 169 patients were operated during this period, of which 139 patients with a KD3 injury satisfied our selection criteria. 21 patients were loss to follow up and excluded from the study population. The final patients included in the study were 118. Patients classified into two groups: MCL treated non-operatively (group 1) and MCL repair (group 2). Demographic data-age, sex, mechanism of injury, time to surgery, graft for both cruciates, associated knee injuries, complications, pre op knee range of movements(ROM) were collected.Follow-up assessment-range of motion (ROM), Stress radiographs for medial laxity at 0° and 30°, anterior and posterior laxity. Functional assessment with Lysholm and IKDC score at 6 months and final follow-up.Statistical analysis with sample t-test/Mann-Whitney U test/Chi-Square test and Fisher’s Exact test.

Results

Mean age 40.3 ± 13.1 years and average follow-up-67.69 ± 15.07 months. Subgroup analysis of MCL tear-46(78%),5(8.5%) and 8(13.6%) in group 1 and 40(67.8%),8(13.6%) and 11(18.6%) in group 2 were femoral, mid substance and tibial sided tears respectively. There was no significant difference between 6 months and final follow up in the functional scores in both groups, but for IKDC which was significantly higher in operative group (p- 0.049). After 6 months and final follow-up, there was a statistically significant difference with lower medial laxity at 0° and 30° in the operative group than non-operative group. Mid substance tear had poor outcome with IKDC of 65.6, Lysholm score of 70.62 when treated non- operatively warranting secondary procedures at a later stage. 28 of 118 (23.72%) patients had complications in both the groups [18(15.22%) in Group 1 and 10(8.5%) in Group 2), but there was no significant difference between the groups (p- 0.717). Among them, 6 patients in group 1, 10 patients in group 2 had stiffness was managed by physiotherapy. 4 had deep vein thrombosis medical management given. 4 patients had superficial infection treated with antibiotics. 1 patient had deep infection needing debridement and PCL graft removal.

Conclusion

MCL operated patients showed better restoration of medial laxity. Mid substance tear showed significant medial laxity in-spite of repair and needs augmentation techniques.
Level of evidence: Level 3 retrospective cohort study.

Keywords: Multi-ligament knee injuries, Knee dislocations, ACL, PCL, non- operative, MCL repair, MCL reconstruction.

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Medial Laxity is Restored Better In MCL Operated Patients than Non-Operated Patients In Single Stage ACL and PCL Reconstruction For Knee Dislocation Type 3 Medial (KD3M) Multi-Ligament Knee Injuries (MLKI)

Medial Laxity is Restored Better In MCL Operated Patients than Non-Operated Patients In Single Stage ACL and PCL Reconstruction For Knee Dislocation Type 3 Medial (KD3M) Multi-Ligament Knee Injuries (MLKI)

Background

Methods

Results

Conclusion

Multi-Ligament Knee Injury ePosters

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Medial Laxity is Restored Better In MCL Operated Patients than Non-Operated Patients In Single Stage ACL and PCL Reconstruction For Knee Dislocation Type 3 Medial (KD3M) Multi-Ligament Knee Injuries (MLKI)

Medial Laxity is Restored Better In MCL Operated Patients than Non-Operated Patients In Single Stage ACL and PCL Reconstruction For Knee Dislocation Type 3 Medial (KD3M) Multi-Ligament Knee Injuries (MLKI)

Background

Methods

Results

Conclusion