Abstract
PurposeIn anterior cruciate ligament (ACL) injuries, concomitant damage to peripheral soft tissues is associated with increased rotatory instability of the knee. The purpose of this study was to investigate the incidence and patterns of medial collateral ligament complex injuries in patients with clinically ‘isolated’ ACL ruptures.MethodsPatients who underwent ACL reconstruction for complete ‘presumed isolated’ ACL rupture between 2015 and 2019 were retrospectively included in this study. Patient’s characteristics and intraoperative findings were retrieved from clinical and surgical documentation. Preoperative MRIs were evaluated and the grade and location of injuries to the superficial MCL (sMCL), dMCL and the posterior oblique ligament (POL) recorded. All patients were clinically assessed under anaesthesia with standard ligament laxity tests.ResultsHundred patients with a mean age of 22.3 ± 4.9 years were included. The incidence of concomitant MCL complex injuries was 67%. sMCL injuries occurred in 62%, dMCL in 31% and POL in 11% with various injury patterns. A dMCL injury was significantly associated with MRI grade II sMCL injuries, medial meniscus ‘ramp’ lesions seen at surgery and bone oedema at the medial femoral condyle (MFC) adjacent to the dMCL attachment site (p < 0.01). Logistic regression analysis identified younger age (OR 1.2, p < 0.05), simultaneous sMCL injury (OR 6.75, p < 0.01) and the presence of bone oedema at the MFC adjacent to the dMCL attachment site (OR 5.54, p < 0.01) as predictive factors for a dMCL injury.ConclusionThe incidence of combined ACL and medial ligament complex injuries is high. Lesions of the dMCL were associated with ramp lesions, MFC bone oedema close to the dMCL attachment, and sMCL injury. Missed AMRI is a risk factor for ACL graft failure from overload and, hence, oedema in the MCL (especially dMCL) demands careful assessment for AMRI, even in the knee lacking excess valgus laxity. This study provides information about specific MCL injury patterns including the dMCL in ACL ruptures and will allow surgeons to initiate individualised treatment.Level of evidenceIII.
Highlights
Rotatory knee instability is a major cause of morbidity for patients
Recent work has highlighted the importance of the medial collateral ligament complex (MCL) complex in the context of anterior cruciate ligament (ACL) injury with deep MCL (dMCL) failure leading to increased external rotation laxity and anteromedial rotatory instability (AMRI) [3, 5, 38, 39]
The presence of bone oedema at the medial femoral condyle (MFC) adjacent to the dMCL attachment site, Magnetic resonance imaging (MRI) grade II superficial MCL (sMCL) injury and ramp lesions are highly correlated with dMCL injury
Summary
Rotatory knee instability is a major cause of morbidity for patients. The medial collateral ligament complex has received surprisingly little attention, especially with regards to anteromedial rotatory instability (AMRI) in combination with a cruciate ligament injury. Combined injuries to the anterior cruciate ligament (ACL) and the medial collateral ligament complex (MCL) comprise the most common twoligament injury of the knee [40]. Recent work has highlighted the importance of the MCL complex in the context of ACL injury with dMCL failure leading to increased external rotation laxity and AMRI [3, 5, 38, 39]. MCL laxity, is a spectrum from pure valgus to pure axial rotation excess and usually a combination
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