EFFICACY COMPARISON BETWEEN DEEP MEDIAL COLLATERAL LIGAMENT REPAIR AND CONSERVATIVE TREATMENT FOR COMPLETE MEDIAL COLLATERAL LIGAMENT RUPTURE_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 ZHANGHangzhou ¹ , BAIXizhuang ² , LIANGQingwei ¹ , WANGYanfeng ¹ , LIUXiangnan ¹ , YOUFuli ¹

1. Department of Sports Medicine and Joint Surgery/Orthopaedics, First Affiliated Hospital of China Medical University, Shenyang Liaoning, 110001, P.R.China;
2. Department of Sports Medicine/Joint Surgery, People's Hospital of Liaoning Province;

Corresponding author：

ZHANGHangzhou, Email: zhanghz1000@163.com

Keywords：

Knee; Medial collateral ligament rupture; Deep medial collateral ligament; Superior medial collateral ligament; Ligament reconstruction

DOI：

10.7507/1002-1892.20160071

Video：

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Objective To compare the clinical efficacy between deep medial collateral ligament (dMCL) repair and conservative treatment for complete MCL rupture. Methods Between August 2009 and December 2013, 36 patients with grade 3 MCL rupture underwent superior MCL (sMCL) reconstruction with tibial Inlay technique. Of 36 cases, 19 received dMCL repair (repair group), and 17 received conservative treatment (conservation group) after sMCL reconstruction. There was no significant difference in gender, age, knee sides, type of injury, disease duration and preoperative medial joint opening, knee Lysholm scores, and International Knee Documentation Committee (IKDC) score between 2 groups (P > 0.05). The Lysholm and IKDC scores, medial joint opening, range of motion (ROM), visual analogue scale (VAS) scores, and complications were used to assess the knee joint function. Results All patients achieved primary incision healing without acute postoperative complications of incision infection and deep vein thrombosis in the lower limb. The patients were followed up 28-65 months (mean, 46.3 months) in the repair group, and 26-69 months (mean, 45.9 months) in the conservation group. No knee stiffness, vascular or nerve injury, and knee joint infection occurred in 2 groups. All the patients recovered medial stability at 2 years postoperatively. At 2 years after operation, no significant difference was shown in knee ROM between 2 groups (t=0.26, P=0.80); the VAS score of the repair group was significantly lower than that of the conservation group (t=5.22, P=0.00); medial joint opening, IKDC score, and Lysholm score were significantly improved when compared with preoperative ones in 2 groups (P < 0.05), but no significant difference was found between 2 groups (P>0.05). Conclusion Whether or not additional dMCL repair is performed can recover medial stability after sMCL reconstruction. However, the additional dMCL repair is better in relieving medial knee pain than the conservative treatment.

Citation： ZHANGHangzhou, BAIXizhuang, LIANGQingwei, WANGYanfeng, LIUXiangnan, YOUFuli. EFFICACY COMPARISON BETWEEN DEEP MEDIAL COLLATERAL LIGAMENT REPAIR AND CONSERVATIVE TREATMENT FOR COMPLETE MEDIAL COLLATERAL LIGAMENT RUPTURE. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(3): 363-367. doi: 10.7507/1002-1892.20160071 Copy

1.	DeLong JM, Waterman BR. Surgical techniques for the reconstruction of medial collateral ligament and posteromedial corner injuries of the knee: a systematic review. Arthroscopy, 2015, 31(11): 2258-2272.e1.
2.	Griffith CJ, LaPrade RF, Johansen S, et al. Medial knee injury: Part 1, static function of the individual components of the main medial knee structures. Am J Sports Med, 2009, 37(9): 1762-1770.
3.	LaPrade RF, Engebretsen AH, Ly TV, et al. The anatomy of the medial part of the knee. J Bone Joint Surg (Am), 2007, 89(9): 2000-2010.
4.	Wijdicks CA, Ewart DT, Nuckley DJ, et al. Structural properties of the primary medial knee ligaments. Am J Sports Med, 2010, 38(8): 1638-1646.
5.	Wijdicks CA, Griffith CJ, LaPrade RF, et al. Medial knee injury: Part 2, load sharing between the posterior oblique ligament and superficial medial collateral ligament. Am J Sports Med, 2009, 37(9): 1771-1776.
6.	Azar FM. Evaluation and treatment of chronic medial collateral ligament injuries of the knee. Sports Med Arthrosc, 2006, 14(2): 84-90.
7.	Duffy PS, Miyamoto RG. Management of medial collateral ligament injuries in the knee: an update and review. Phys Sportsmed, 2010, 38(2): 48-54.
8.	Lubowitz JH, MacKay G, Gilmer B. Knee medial collateral ligament and posteromedial corner anatomic repair with internal bracing. Arthrosc Tech, 2014, 3(4): e505-508.
9.	Jacobson KE, Chi FS. Evaluation and treatment of medial collateral ligament and medial-sided injuries of the knee. Sports Med Arthrosc, 2006, 14(2): 58-66.
10.	Battaglia MJ 2nd, Lenhoff MW, Ehteshami JR, et al. Medial collateral ligament injuries and subsequent load on the anterior cruciate ligament: a biomechanical evaluation in a cadaveric model. Am J Sports Med, 2009, 37(2): 305-311.
11.	Chen L, Kim PD, Ahmad CS, et al. Medial collateral ligament injuries of the knee: current treatment concepts. Curr Rev Musculoskelet Med, 2008, 1(2): 108-113.
12.	Dong J, Wang XF, Men X, et al. Surgical treatment of acute grade III medial collateral ligament injury combined with anterior cruciate ligament injury: anatomic ligament repair versus triangular ligament reconstruction. Arthroscopy, 2015, 31(6): 1108-1116.
13.	Fetto JF, Marshall JL. Medial collateral ligament injuries of the knee: a rationale for treatment. Clin Orthop Relat Res, 1978, (132): 206-218.
14.	Madonna V, Screpis D, Condello V, et al. A novel technique for combined medial collateral ligament and posterior oblique ligament reconstruction: technical note. Knee Surg Sports Traumatol Arthrosc, 2015, 23(10): 2814-2819.
15.	Koga H, Muneta T, Yagishita K, et al. Surgical management of grade 3 medial knee injuries combined with cruciate ligament injuries. Knee Surg Sports Traumatol Arthrosc, 2012, 20(1): 88-94.
16.	张杭州, 白希壮, 王琳, 等.同种异体跟腱胫骨Inlay技术重建膝关节内侧副韧带的疗效观察.中国修复重建外科杂志, 2014, 28(2): 223-226.
17.	Zhang HZ, Bai XZ, Sun Y, et al. Tibial inlay reconstruction of the medial collateral ligament using Achilles tendon allograft for the treatment of medial instability of the knee. Knee Surg Sports Traumatol Arthrosc, 2014, 22(2): 279-284.
18.	白希壮, 王慧声, 郭磊, 等.异体跟腱骨移植对后交叉韧带及后外侧结构损伤的联合重建.中华创伤杂志, 2006, 22(9): 647-651.
19.	Marx RG, Hetsroni I. Surgical technique: medial collateral ligament reconstruction using Achilles allograft for combined knee ligament injury. Clin Orthop Relat Res, 2012, 470(3): 798-805.
20.	Jones L, Bismil Q, Alyas F, et al. Persistent symptoms following non operative management in low grade MCL injury of the knee-The role of the deep MCL. Knee, 2009, 16(1): 64-68.
21.	James SL, Ali K, Pocock C, et al. Ultrasound guided dry needling and autologous blood injection for patellar tendinosis. Br J Sports Med, 2007, 41(8): 518-521.
22.	Anitua E, Andía I, Sanchez M, et al. Autologous preparations rich in growth factors promote proliferation and induce VEGF and HGF production by human tendon cells in culture. J Orthop Res, 2005, 23(2): 281-286.
23.	Iwasaki M, Nakahara H, Nakata K, et al. Regulation of proliferation and osteochondrogenic differentiation of periosteum-derived cells by transforming growth-factor beta and basic fibroblast growth factor. J Bone Joint Surg (Am), 1995, 77(4): 543-554.

1. DeLong JM, Waterman BR. Surgical techniques for the reconstruction of medial collateral ligament and posteromedial corner injuries of the knee: a systematic review. Arthroscopy, 2015, 31(11): 2258-2272.e1.
2. Griffith CJ, LaPrade RF, Johansen S, et al. Medial knee injury: Part 1, static function of the individual components of the main medial knee structures. Am J Sports Med, 2009, 37(9): 1762-1770.
3. LaPrade RF, Engebretsen AH, Ly TV, et al. The anatomy of the medial part of the knee. J Bone Joint Surg (Am), 2007, 89(9): 2000-2010.
4. Wijdicks CA, Ewart DT, Nuckley DJ, et al. Structural properties of the primary medial knee ligaments. Am J Sports Med, 2010, 38(8): 1638-1646.
5. Wijdicks CA, Griffith CJ, LaPrade RF, et al. Medial knee injury: Part 2, load sharing between the posterior oblique ligament and superficial medial collateral ligament. Am J Sports Med, 2009, 37(9): 1771-1776.
6. Azar FM. Evaluation and treatment of chronic medial collateral ligament injuries of the knee. Sports Med Arthrosc, 2006, 14(2): 84-90.
7. Duffy PS, Miyamoto RG. Management of medial collateral ligament injuries in the knee: an update and review. Phys Sportsmed, 2010, 38(2): 48-54.
8. Lubowitz JH, MacKay G, Gilmer B. Knee medial collateral ligament and posteromedial corner anatomic repair with internal bracing. Arthrosc Tech, 2014, 3(4): e505-508.
9. Jacobson KE, Chi FS. Evaluation and treatment of medial collateral ligament and medial-sided injuries of the knee. Sports Med Arthrosc, 2006, 14(2): 58-66.
10. Battaglia MJ 2nd, Lenhoff MW, Ehteshami JR, et al. Medial collateral ligament injuries and subsequent load on the anterior cruciate ligament: a biomechanical evaluation in a cadaveric model. Am J Sports Med, 2009, 37(2): 305-311.
11. Chen L, Kim PD, Ahmad CS, et al. Medial collateral ligament injuries of the knee: current treatment concepts. Curr Rev Musculoskelet Med, 2008, 1(2): 108-113.
12. Dong J, Wang XF, Men X, et al. Surgical treatment of acute grade III medial collateral ligament injury combined with anterior cruciate ligament injury: anatomic ligament repair versus triangular ligament reconstruction. Arthroscopy, 2015, 31(6): 1108-1116.
13. Fetto JF, Marshall JL. Medial collateral ligament injuries of the knee: a rationale for treatment. Clin Orthop Relat Res, 1978, (132): 206-218.
14. Madonna V, Screpis D, Condello V, et al. A novel technique for combined medial collateral ligament and posterior oblique ligament reconstruction: technical note. Knee Surg Sports Traumatol Arthrosc, 2015, 23(10): 2814-2819.
15. Koga H, Muneta T, Yagishita K, et al. Surgical management of grade 3 medial knee injuries combined with cruciate ligament injuries. Knee Surg Sports Traumatol Arthrosc, 2012, 20(1): 88-94.
16. 张杭州, 白希壮, 王琳, 等.同种异体跟腱胫骨Inlay技术重建膝关节内侧副韧带的疗效观察.中国修复重建外科杂志, 2014, 28(2): 223-226.
17. Zhang HZ, Bai XZ, Sun Y, et al. Tibial inlay reconstruction of the medial collateral ligament using Achilles tendon allograft for the treatment of medial instability of the knee. Knee Surg Sports Traumatol Arthrosc, 2014, 22(2): 279-284.
18. 白希壮, 王慧声, 郭磊, 等.异体跟腱骨移植对后交叉韧带及后外侧结构损伤的联合重建.中华创伤杂志, 2006, 22(9): 647-651.
19. Marx RG, Hetsroni I. Surgical technique: medial collateral ligament reconstruction using Achilles allograft for combined knee ligament injury. Clin Orthop Relat Res, 2012, 470(3): 798-805.
20. Jones L, Bismil Q, Alyas F, et al. Persistent symptoms following non operative management in low grade MCL injury of the knee-The role of the deep MCL. Knee, 2009, 16(1): 64-68.
21. James SL, Ali K, Pocock C, et al. Ultrasound guided dry needling and autologous blood injection for patellar tendinosis. Br J Sports Med, 2007, 41(8): 518-521.
22. Anitua E, Andía I, Sanchez M, et al. Autologous preparations rich in growth factors promote proliferation and induce VEGF and HGF production by human tendon cells in culture. J Orthop Res, 2005, 23(2): 281-286.
23. Iwasaki M, Nakahara H, Nakata K, et al. Regulation of proliferation and osteochondrogenic differentiation of periosteum-derived cells by transforming growth-factor beta and basic fibroblast growth factor. J Bone Joint Surg (Am), 1995, 77(4): 543-554.

Chinese Journal of Reparative and Reconstructive Surgery

EFFICACY COMPARISON BETWEEN DEEP MEDIAL COLLATERAL LIGAMENT REPAIR AND CONSERVATIVE TREATMENT FOR COMPLETE MEDIAL COLLATERAL LIGAMENT RUPTURE

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