Good clinical outcome of nonoperatively treated low grade medial collateral ligament injuries combined with primary anterior cruciate ligament reconstruction

초록

Objective The purpose of this study was to determine whether functional outcomes differ between patients undergoing an anterior cruciate ligament (ACL) reconstruction with a concomitant, nonoperatively treated grade I and II medial collateral ligament (MCL) injury (ACL + MCL group) and those undergoing an isolated ACL reconstruction (ACL group). Methods A total of 153 patients (34 ACL + MCL group, 119 ACL group, mean age: 28.6 years) who were available for a 2-year follow-up without re-injuries or requiring revision were included in this study. Preoperative magnetic resonance imaging was used to diagnose the MCL injury and a grade of MCL laxity was evaluated by physical examination. Patient-reported outcomes (the Lysholm score, the Tegner activity score, the International Knee Documentation Committee subjective knee form score [IKDC 2000], the Knee Injury and Osteoarthritis Outcome Score (KOOS), the Anterior Cruciate Ligament-Return to Sport after Injury scale (ACL-RSI), and return to pre-injury level of sports activity at 2 years after ACL reconstruction were compared between the two groups. Statistical significance was set at a p-value <0.05. Results At the 2-year follow-up, no statistically significant differences of Lysholm score (84.7 vs 83.2; p = 0.740), Tegner activity score (6.2 vs 6.3; p = 0.829), IKDC 2000 subjective score (77.1 vs 78.9; p = 0.572), KOOS symptom (81 vs 78.5; p = 0.454); pain (90.1 vs 93.6, p = 0.513), daily living (96.4 vs 94.5; p = 0.172), sports and recreation (80.5 vs 77.2; p = 0.352), quality of life (39.2 vs 43.1; p = 0.172), ACL-RSI emotion (53.4 vs 53.7; p = 0.953); confidence (63 vs 63.1; p = 0.970); risk (55.6 vs 52.5; p = 0.565) and ACL-RSI total (58.5 vs 57; p = 0.679) were observed. There were no statistically significant differences of rates of return to pre-injury level of sports activity (44% vs 29%, p = 0.092). Conclusion Similar patient-reported, functional, and return-to-sport outcomes were found for nonoperatively treated grade I and II MCL injuries combined with ACL reconstruction compared to those of isolated ACL reconstruction at the 2-year follow-up.

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