Article
Lower failure rates and improved patient outcome due to reconstruction of the MCL and revision ACL reconstruction in chronic medial knee instability
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Published: | October 26, 2021 |
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Objectives: Concomitant lesion of the medial collateral ligament (MCL) is associated with a greater risk of anterior cruciate ligament (ACL) graft failure. The aim of this study was to compare two medial stabilization techniques in revision ACL reconstruction (ACLR) in patients with concomitant chronic medial knee instability.
Methods: In a retrospective study, we included 56 patients with revision ACLR and chronic medial knee instability grade 2 to compare medial surgical techniques (MCL reconstruction (n=17) vs. repair) (n=36). Postoperative failure of the revision ACLR (primary aim) was defined as side-to-side difference in Rolimeter® testing > 5mm or pivot shift grade >2. Clinical parameters and postoperative functional scores (secondary aim) were evaluated with a mean follow-up of 28.8 ± 9.7 (24-69) months.
Results and Conclusion: Revision ACLR was performed in 53 patients (males=33, females=20, mean age 31.3 ± 12 years) with additional medial instability grade 2. Failure occurred in 5.9% (n=1) in the group of MCL reconstruction, whereas 36.1 % (n=13) of patients with MCL repair showed a failed revision ACLR (p=0.02). In the postoperative assessment, the anterior side-to-side difference in Rolimeter testing was significantly reduced (1.5 ± 1.9mm vs. 2.9 ± 2.3mm, p=.037) and medial knee instability occurred significantly less (18% vs 50%, p=,025) in the group of MCL reconstruction than in the group of MCL repair. Also, in the logistic regression patients showed a 9 times elevated risk of failure when a medial repair was performed (p=0.043). Patient reported outcomes were increased in the group of MCL reconstruction compared to MCL repair but only the Lysholm score showed a significant difference (Tegner 5.6±1. vs. 5.3±1.6, n.s.; IKDC 80.3±16.6 vs. 73.6±16.4, n.s., Lysholm 82.9±13.6 vs. 75.1±21.1, p=.047).
MCL reconstruction leads to lower failure rates in combined revision ACLR and chronic medial instability compared to MCL repair. MCL reconstruction was superior to MCL repair as lower postoperative anterior instability, an increased Lysholm score and less medial instability were present after revision ACLR. MCL repair was associated with a 9 times greater risk of failure.