Treatment of medial-sided injuries in patients with early bicruciate ligament reconstruction for knee dislocation

Mikko A Jokela,Joonas M Lindahl,Jyrki Halinen,Mika P Koivikko,Jan Lindahl,Tatu J Mäkinen

doi:10.1007/s00167-020-06207-x

Abstract

PurposeIn knee dislocation with bicruciate ligament and medial side injury (KDIIIM), treatment method of medial side injuries is controversial. The purpose of this study was to evaluate the outcomes of non-operative treatment of proximal and midsubstance and operative treatment of distal avulsion medial collateral ligament (MCL) ruptures in patients with early bicruciate reconstruction.MethodsOne-hundred and forty-seven patients with a knee dislocation and bicruciate ligament injury (KDII-KDV) were identified. Sixty-two patients had KDIIIM injury. Of these, 24 patients were excluded and 13 were lost to follow-up. With a minimum of 2 years of follow-up, IKDC2000 (subjective and objective), Lysholm and Tegner scores and stress radiographs were recorded.ResultsTwenty-five patients were available for follow-up: 18 had a proximal or midsubstance grade-III MCL rupture (proximal MCL group) and 7 had a distal MCL avulsion (distal MCL group). In the proximal MCL and distal MCL groups, respectively, median IKDC2000 subjective scores were 80 (range 57–99) and 62 (range 39–87), and median Lysholm scores were 88 (range 57–99) and 75 (range 40–100). The median medial opening (side-to-side difference) was 2.4 mm (range 0.1–9.2) in the proximal MCL group and 2.5 mm (range 0.2–4.8) in the distal MCL group.ConclusionWe found acceptable recorded outcomes in patients who underwent non-operative treatment of proximal and midsubstance grade-III MCL rupture and operative treatment of distal MCL avulsion with early bicruciate ligament reconstruction.Level of evidenceLevel IV

Highlights

Knee dislocation is a rare injury typically caused by highenergy trauma, but it can occur with low-energy insult during sports or even in a same-level fall [37]
Twenty-five patients were available for final follow-up: 18 in the proximal medial collateral ligament (MCL) group and 7 in the distal MCL group
The median medial knee laxity in the valgus stress test measured from Telos radiographs was 2.4 mm in the proximal MCL group and 2.5 mm in the distal MCL group

Summary

Introduction

Knee dislocation is a rare injury typically caused by highenergy trauma, but it can occur with low-energy insult during sports or even in a same-level fall [37]. Operative treatment of both cruciate ligaments in the acute phase seems to lead to good outcomes [7, 9, 14, 29]. Good results have been reported with both non-operative and operative treatments of medial side injuries and bicruciate ligament reconstruction in the acute phase [3, 7, 22, 34, 38]. Literature is scarce regarding treatment of acute knee dislocation with bicruciate and medial side injury [20, 24, 35, 38]

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