Primary ACL Reconstruction and Conservative MCL Treatment Results in Higher Failure Rates than Simultaneous Primary ACLR and MCL Reconstruction

Primary ACL Reconstruction and Conservative MCL Treatment Results in Higher Failure Rates than Simultaneous Primary ACLR and MCL Reconstruction

Mohammad Razi, MD, IRAN, ISLAMIC REPUBLIC OF Mohammad Soleimani, MD, MPH, IRAN, ISLAMIC REPUBLIC OF Haleh Dadgostar, MD, IRAN, ISLAMIC REPUBLIC OF Saiid Razi, MD, IRAN, ISLAMIC REPUBLIC OF

Iran University of Medical Scineces, Tehran, Tehran, IRAN, ISLAMIC REPUBLIC OF


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Anatomic Location

Diagnosis / Condition

Anatomic Structure

Diagnosis Method

Ligaments


Summary: Primary ACL Reconstruction and Conservative MCL Treatment Results in Higher Failure Rates than Simultaneous Primary ACLR and MCL Reconstruction


Introduction

The injury of the anterior cruciate ligament (ACL) and medial collateral ligament (MCL) is the most common combination of ligament injury in the knee. Many authors support the conservative treatment of MCL. This study aimed to compare the outcomes of simultaneous ACLR and MCL reconstruction with ACLR and conservative MCL treatment in cases of combined ACL and MCL injury.

Methods

We evaluated consecutive patients with combined ACL and MCL injuries who underwent surgical treatment over five years. We evaluated age, sex, side, postoperative range of motion (ROM), pain intensity (visual analog scale [VAS]), functional outcomes (Tegner-Lysholm and International Knee Documentation Committee Subjective Knee Form [IKDC] scores), return to sports, return to work, activity level (Marx activity scale), and graft failure rate. All patients were followed for at least twelve months.

Results

A total of 110 patients were included, with 67 undergoing ACLR and conservative MCL treatment (ACL group) and 43 undergoing ACLR and MCL reconstruction (ACL + MCL group). The age (P: 0.216), sex (P: 0.118), side (P: 0.468), and follow-up (P: 0.958) were comparable between the groups. The extension (P: 0.740), flexion (P: 0.132), VAS (P: 0.654), Tegner-Lysholm score (P: 0.696), IKDC scores (P: 0.212), time for the return to sports (P: 0.625), time for the return to work (P: 0.503), and activity level (P: 0.098) did not differ significantly between the groups. The graft failure rate was significantly lower in the ACL + MCL group (1, 2.3%) than in the ACL group (11 cases, 16.4%) (P: 0.026).

Conclusion

Postoperative ROM, pain intensity, functional outcomes, time for the return to work and sports, and activity level are not significantly different in patients undergoing primary arthroscopic simultaneous arthroscopic ACLR and MCL reconstruction or ACLR and conservative MCL treatment after combined ACL and MCL injury. However, the rate of graft failure following ACLR and conservative MCL treatment is significantly higher, indicating the need for surgical management of the MCL along with ACLR.