Surgical management of grade 3 medial knee injuries combined with cruciate ligament injuries

Knee Surg Sports Traumatol Arthrosc. 2012 Jan;20(1):88-94. doi: 10.1007/s00167-011-1541-x. Epub 2011 May 10.

Abstract

Purpose: Although various surgical procedures have attempted to restore valgus stability in medial knee injuries, so far none has achieved satisfactory results. The purpose of this study was to assess clinical outcome for patients with grade 3 valgus instability who were treated according to our surgical management strategy.

Methods: Eighteen patients with both acute and chronic grade 3 medial knee injuries, all of which had combined cruciate ligament injuries, were treated with a proximal advancement of both the superficial medial collateral ligament (MCL) and posterior oblique ligament together with underlying deep MCL and joint capsule, in conjunction with cruciate ligament reconstructions in chronic phase. Augmentation with doubled semitendinosus tendon was added in 7 patients whose medial knee stability had been considered to be insufficient with only the proximal advancement procedure. They were evaluated preoperatively and at final follow-up.

Results: Manual valgus laxities at 0° and 30°, as well as side-to-side difference in medial joint opening in stress radiograph, were significantly improved at final follow-up. The Lysholm knee scale was also significantly improved. Median values of the subjective evaluations of the patients' satisfaction, stability and sports performance level measured with visual analogue scale at final follow-up were 82 (60-100), 94 (71-100) and 88 (60-100), respectively.

Conclusions: Clinical outcomes of our surgical management strategy were reasonable in terms of restoring medial knee stability. This treatment protocol can help determine the surgical management of grade 3 medial knee injuries combined with cruciate ligament injuries.

Level of evidence: Retrospective case series, Level IV.

Publication types

  • Evaluation Study

MeSH terms

  • Adolescent
  • Adult
  • Anterior Cruciate Ligament / surgery
  • Anterior Cruciate Ligament Injuries*
  • Anterior Cruciate Ligament Reconstruction*
  • Female
  • Humans
  • Joint Instability / etiology
  • Joint Instability / surgery*
  • Knee Injuries / complications
  • Knee Injuries / surgery*
  • Male
  • Medial Collateral Ligament, Knee / surgery
  • Patient Satisfaction
  • Posterior Cruciate Ligament / injuries*
  • Posterior Cruciate Ligament / surgery
  • Range of Motion, Articular
  • Recovery of Function
  • Retrospective Studies
  • Tendons / transplantation
  • Trauma Severity Indices
  • Treatment Outcome
  • Young Adult