Anatomic medial knee reconstruction restores stability and function at minimum 2 years follow-up

Abstract

Purpose

Chronic grade 3 tears of the medial collateral ligament and posterior oblique ligament may result in valgus laxity and anteromedial rotational instability after an isolated or multiligament injury. The purpose of this study was to prospectively analyze the restoration of physiologic medial laxity as assessed on stress radiography and patient reported subjective functional outcomes in patients who undergo an anatomic medial knee reconstruction.

Methods

This was a prospective study which included patients with chronic (> 6 weeks old) posteromedial corner injury with or without other ligament and meniscus lesions. Pre- and post-operative valgus stress radiographs were performed in 20° knee flexion and functional outcome was recorded as per the International Knee Documentation Committee (IKDC) and Lysholm scores. All patients underwent anatomic medial reconstruction with two femoral and two tibial sockets using ipsilateral hamstring tendon autograft. Simultaneous ligament and meniscus surgery was performed as per the associated injury pattern. All patients were followed up for a minimum of 24 months post-surgery.

Results

Thirty-four patients (23 males, 11 females) were enrolled in the study and all were available till final follow-up of mean 49.7 ± 14.9 months. The mean age was 30.6 ± 7.9 (18–52 years). Two patients had isolated medial sided lesions and 23 had associated ligament injuries. The mean follow up was 49.7 (24–72) months. The mean IKDC score improved from 58 ± 8.3 to 78.2 ± 9.5 (p < 0.001). Post-operatively there were 15 excellent, 11 good and 8 fair outcomes on Lysholm score. The mean pre-operative valgus side-to-side opening improved from 7.5 ± 2.5 mm to 1.2 ± 0.7 mm on stress radiography (p < 0.001).

Conclusion

Anatomic reconstruction of the superficial medial collateral and posterior oblique ligaments restore stability in a consistent manner cases of chronic grade 3 instability. The objective functional results, subjective outcomes and measures of static medial stability are satisfactory in the short term.

Level of Evidence

IV

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Acknowledgements

The authors acknowledge the assistance received from Dr. Vikram Kakatkar for data collection and Mr. Shrivallabh P. Sane (Lecturer in Biostatistics, Maharashtra Institute of Mental Health, Pune) for the statistical analysis.

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Affiliations

Authors

Contributions

ST, AS and AG were responsible for conceiving the idea and planning the study. ST and AS were involved in the actual conduct of all surgical procedures. AS and SP performed the data analysis, statistical analysis and prepared the manuscript. AS performed the literature search. ST, SP and AG reviewed and edited the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Sachin Tapasvi.

Ethics declarations

Conflict of interest

ST: Dr. Tapasvi reports personal fees and paid presentations for Arthrex, Zimmer Biomet and Smith and Nephew; royalties from Jaypee Medical Publishers, New Delhi; and serves on the boards of ISAKOS, APKASS and Indian Arthroscopy Society. All disclosures are outside the submitted work. Anshu Shekhar and Shantanu Patil: None. Alan Getgood: Dr. Getgood reports personal fees from Smith and Nephew and Olympus; research support from Smith and Nephew and Ossur; and royalties from Smith and Nephew and Graymont. All disclosures are outside the submitted work.

Funding

None.

Ethical approval

Institutional Review Board approval from Sahyadri Clinical Research and Development Center obtained prior patient recruitment. Final study results also submitted to the board.

Informed Consent

Informed written consent for participation in the study obtained from all patients.

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Tapasvi, S., Shekhar, A., Patil, S. et al. Anatomic medial knee reconstruction restores stability and function at minimum 2 years follow-up. Knee Surg Sports Traumatol Arthrosc (2021). https://doi.org/10.1007/s00167-021-06502-1

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Keywords

  • Medial collateral ligament
  • Posterior oblique ligament
  • Anatomic reconstruction
  • MCL reconstruction
  • Valgus stress
  • Stress radiography
  • Functional outcome