Anterior Cruciate Ligament and Medial Collateral Ligament Injuries

Matthew Bollier; Patrick A. Smith

doi:10.1055/s-0034-1381961

The Journal of Knee Surgery, Inhaltsverzeichnis

J Knee Surg 2014; 27(05): 359-368
DOI: 10.1055/s-0034-1381961

Special Focus Section

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Anterior Cruciate Ligament and Medial Collateral Ligament Injuries

Matthew Bollier

¹Department of Orthopaedic Surgery, University of Iowa Sports Medicine, Iowa City, Iowa

,

Patrick A. Smith

²Columbia Orthopaedic Group, Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri

› Institutsangaben

Abstract

The diagnosis and treatment of combined anterior cruciate ligament (ACL) and medial collateral ligament (MCL) injuries have evolved over the past 30 years. A detailed physical examination along with careful review of the magnetic resonance imaging and stress radiographs will guide decision making. Early ACL reconstruction and acute MCL repair are recommended when there is increased medial joint space opening with valgus stress in extension, a significant meniscotibial deep MCL injury (high-riding medial meniscus), or a displaced tibial-sided superficial MCL avulsion (stener lesion of the knee). Delayed ACL reconstruction to allow for MCL healing is advised when increased valgus laxity is present only at 30 degrees of flexion and not at 0 degree. However, at the time of ACL surgery, medial stability has to be re-assessed after the reconstruction is completed. In patients with neutral alignment in the chronic setting, graft reconstruction of both the ACL and MCL is recommended.

Keywords

medial collateral ligament - meniscotibial - posterior oblique ligament - valgus stress test

Volltext

Referenzen

References
1 Fetto JF, Marshall JL. Medial collateral ligament injuries of the knee: a rationale for treatment. Clin Orthop Relat Res 1978; (132) 206-218
2 Hughston JC. A surgical approach to the medial and posterior ligaments of the knee. Clin Orthop Relat Res 1973; (91) 29-33
3 Hughston JC, Eilers AF. The role of the posterior oblique ligament in repairs of acute medial (collateral) ligament tears of the knee. J Bone Joint Surg Am 1973; 55 (5) 923-940
4 Miyamoto RG, Bosco JA, Sherman OH. Treatment of medial collateral ligament injuries. J Am Acad Orthop Surg 2009; 17 (3) 152-161
5 Indelicato PA. Non-operative treatment of complete tears of the medial collateral ligament of the knee. J Bone Joint Surg Am 1983; 65 (3) 323-329
6 Indelicato PA, Hermansdorfer J, Huegel M. Nonoperative management of complete tears of the medial collateral ligament of the knee in intercollegiate football players. Clin Orthop Relat Res 1990; (256) 174-177
7 Ellsasser JC, Reynolds FC, Omohundro JR. The non-operative treatment of collateral ligament injuries of the knee in professional football players. An analysis of seventy-four injuries treated non-operatively and twenty-four injuries treated surgically. J Bone Joint Surg Am 1974; 56 (6) 1185-1190
8 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
9 Griffith CJ, LaPrade RF, Johansen S, Armitage B, Wijdicks C, Engebretsen L. 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
10 LaPrade RF, Engebretsen AH, Ly TV, Johansen S, Wentorf FA, Engebretsen L. The anatomy of the medial part of the knee. J Bone Joint Surg Am 2007; 89 (9) 2000-2010
11 Wijdicks CA, Brand EJ, Nuckley DJ, Johansen S, LaPrade RF, Engebretsen L. Biomechanical evaluation of a medial knee reconstruction with comparison of bioabsorbable interference screw constructs and optimization with a cortical button. Knee Surg Sports Traumatol Arthrosc 2010; 18 (11) 1532-1541
12 Wijdicks CA, Ewart DT, Nuckley DJ, Johansen S, Engebretsen L, Laprade RF. Structural properties of the primary medial knee ligaments. Am J Sports Med 2010; 38 (8) 1638-1646
13 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
14 Phisitkul P, James SL, Wolf BR, Amendola A. MCL injuries of the knee: current concepts review. Iowa Orthop J 2006; 26: 77-90
15 Warren LFMJ, Marshall JL. The supporting structures and layers on the medial side of the knee: an anatomical analysis. J Bone Joint Surg Am 1979; 61 (1) 56-62
16 James SL. Surgical anatomy of the knee. Fortschr Med 1978; 96 (4) 141-146 , 166
17 Marchant Jr MH, Tibor LM, Sekiya JK, Hardaker Jr WT, Garrett Jr WE, Taylor DC. Management of medial-sided knee injuries, part 1: medial collateral ligament. Am J Sports Med 2011; 39 (5) 1102-1113
18 Tibor LM, Marchant Jr MH, Taylor DC, Hardaker Jr WT, Garrett Jr WE, Sekiya JK. Management of medial-sided knee injuries, part 2: posteromedial corner. Am J Sports Med 2011; 39 (6) 1332-1340
19 Wijdicks CA, Willimon SC, LaPrade RF. Surgical treatment of acute and chronic medial knee injuries. Tech Knee Surg 2011; 10 (1) 11-18
20 Grood ES, Noyes FR, Butler DL, Suntay WJ ; al Ge. Ligamentous and capsular restraints preventing straight medial and lateral laxity in intact human cadaver knees. J Bone Joint Surg Am 1981; 63 (8) 1257-1269
21 Shapiro MS, Markolf KL, Finerman GA, Mitchell PW. The effect of section of the medial collateral ligament on force generated in the anterior cruciate ligament. J Bone Joint Surg Am 1991; 73 (2) 248-256
22 Shoemaker SCMK, Markolf KL. Effects of joint load on the stiffness and laxity of ligament-deficient knees. An in vitro study of the anterior cruciate and medial collateral ligaments. J Bone Joint Surg Am 1985; 67 (1) 136-146
23 Warren LA, Marshall JL, Girgis F. The prime static stabilizer of the medical side of the knee. J Bone Joint Surg Am 1974; 56 (4) 665-674
24 Haimes JL, Wroble RR, Grood ES, Noyes FR. Role of the medial structures in the intact and anterior cruciate ligament-deficient knee. Limits of motion in the human knee. Am J Sports Med 1994; 22 (3) 402-409
25 Mains DB, Andrews JG, Stonecipher T. Medial and anterior-posterior ligament stability of the human knee, measured with a stress apparatus. Am J Sports Med 1977; 5 (4) 144-153
26 Kurzweil PR, Kelley ST. Physical examination and imaging of the medial collateral ligament and posteromedial corner of the knee. Sports Med Arthrosc 2006; 14 (2) 67-73
27 Wijdicks CA, Griffith CJ, Johansen S, Engebretsen L, LaPrade RF. Injuries to the medial collateral ligament and associated medial structures of the knee. J Bone Joint Surg Am 2010; 92 (5) 1266-1280
28 Indelicato PA. Isolated Medial Collateral Ligament Injuries in the Knee. J Am Acad Orthop Surg 1995; 3 (1) 9-14
29 Hughston JC, Andrews JR, Cross MJ, Moschi A. Classification of knee ligament instabilities. Part I. The medial compartment and cruciate ligaments. J Bone Joint Surg Am 1976; 58 (2) 159-172
30 Laprade RF, Bernhardson AS, Griffith CJ, Macalena JA, Wijdicks CA. Correlation of valgus stress radiographs with medial knee ligament injuries: an in vitro biomechanical study. Am J Sports Med 2010; 38 (2) 330-338
31 Bergfeld J. Symposium: functional rehabilitation of isolated medial collateral ligament sprains. First-, second-, and third-degree sprains. Am J Sports Med 1979; 7 (3) 207-209
32 Hughston JC. The importance of the posterior oblique ligament in repairs of acute tears of the medial ligaments in knees with and without an associated rupture of the anterior cruciate ligament. Results of long-term follow-up. J Bone Joint Surg Am 1994; 76 (9) 1328-1344
33 Kannus P. Long-term results of conservatively treated medial collateral ligament injuries of the knee joint. Clin Orthop Relat Res 1988; (226) 103-112
34 Narvani A, Mahmud T, Lavelle J, Williams A. Injury to the proximal deep medial collateral ligament: a problematical subgroup of injuries. J Bone Joint Surg Br 2010; 92 (7) 949-953
35 Reider B, Sathy MR, Talkington J, Blyznak N, Kollias S. Treatment of isolated medial collateral ligament injuries in athletes with early functional rehabilitation. A five-year follow-up study. Am J Sports Med 1994; 22 (4) 470-477
36 Woo SL, Vogrin TM, Abramowitch SD. Healing and repair of ligament injuries in the knee. J Am Acad Orthop Surg 2000; 8 (6) 364-372
37 Anderson DR, Weiss JA, Takai S, Ohland KJ, Woo SL. Healing of the medial collateral ligament following a triad injury: a biomechanical and histological study of the knee in rabbits. J Orthop Res 1992; 10 (4) 485-495
38 Corten K, Hoser C, Fink C, Bellemans J. Case reports: a Stener-like lesion of the medial collateral ligament of the knee. Clin Orthop Relat Res 2010; 468 (1) 289-293
39 Ichiba A, Nakajima M, Fujita A, Abe M. The effect of medial collateral ligament insufficiency on the reconstructed anterior cruciate ligament: a study in the rabbit. Acta Orthop Scand 2003; 74 (2) 196-200
40 Carson EW, Anisko EM, Restrepo C, Panariello RA, O'Brien SJ, Warren RF. Revision anterior cruciate ligament reconstruction: etiology of failures and clinical results. J Knee Surg 2004; 17 (3) 127-132
41 Jaureguito JW, Paulos LE. Why grafts fail. Clin Orthop Relat Res 1996; (325) 25-41
42 Battaglia II MJ, 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
43 Ma CB, Papageogiou CD, Debski RE, Woo SL ; Ma Cea. Interaction between the ACL graft and MCL in a combined ACL+MCL knee injury using a goat model. Acta Orthop Scand 2000; 71 (4) 387-393
44 Zaffagnini S, Bignozzi S, Martelli S, Lopomo N, Marcacci M. Does ACL reconstruction restore knee stability in combined lesions?: An in vivo study. Clin Orthop Relat Res 2007; 454 (454) 95-99
45 Robins AJ, Newman AP, Burks RT. Postoperative return of motion in anterior cruciate ligament and medial collateral ligament injuries. The effect of medial collateral ligament rupture location. Am J Sports Med 1993; 21 (1) 20-25
46 Shelbourne KD, Porter DA. Anterior cruciate ligament-medial collateral ligament injury: nonoperative management of medial collateral ligament tears with anterior cruciate ligament reconstruction. A preliminary report. Am J Sports Med 1992; 20 (3) 283-286
47 Noyes FR, Barber-Westin SD. The treatment of acute combined ruptures of the anterior cruciate and medial ligaments of the knee. Am J Sports Med 1995; 23 (4) 380-389
48 Halinen J, Lindahl J, Hirvensalo E. Range of motion and quadriceps muscle power after early surgical treatment of acute combined anterior cruciate and grade-III medial collateral ligament injuries. A prospective randomized study. J Bone Joint Surg Am 2009; 91 (6) 1305-1312
49 Koga H, Muneta T, Yagishita K, Ju YJ, Sekiya I. Surgical management of grade 3 medial knee injuries combined with cruciate ligament injuries. Knee Surg Sports Traumatol Arthrosc 2012; 20 (1) 88-94
50 Halinen J, Lindahl J, Hirvensalo E, Santavirta S. Operative and nonoperative treatments of medial collateral ligament rupture with early anterior cruciate ligament reconstruction: a prospective randomized study. Am J Sports Med 2006; 34 (7) 1134-1140
51 Hillard-Sembell D, Daniel DM, Stone ML, Dobson BE, Fithian DC. Combined injuries of the anterior cruciate and medial collateral ligaments of the knee. Effect of treatment on stability and function of the joint. J Bone Joint Surg Am 1996; 78 (2) 169-176
52 Sandberg R, Balkfors B, Nilsson B, Westlin N. Operative versus non-operative treatment of recent injuries to the ligaments of the knee. A prospective randomized study. J Bone Joint Surg Am 1987; 69 (8) 1120-1126
53 Hubert MG, Stannard JP. Surgical treatment of acute and chronic anterior and posterior cruciate ligament and medial-side injuries of the knee. Sports Med Arthrosc 2011; 19 (2) 104-109
54 Fanelli GC, Edson CJ, Orcutt DR, Harris JD, Zijerdi D. Treatment of combined anterior cruciate-posterior cruciate ligament-medial-lateral side knee injuries. J Knee Surg 2005; 18 (3) 240-248
55 Grant JA, Tannenbaum E, Miller BS, Bedi A. Treatment of combined complete tears of the anterior cruciate and medial collateral ligaments. Arthroscopy 2012; 28 (1) 110-122
56 Stephenson DR, Rueff D, Johnson DL. MRI and arthroscopic analysis of collateral knee ligament injuries in combined knee ligament injuries. Orthopedics 2010; 33 (3) 187-189
57 Medvecky MJ, Noyes FR. Surgical approaches to the posteromedial and posterolateral aspects of the knee. J Am Acad Orthop Surg 2005; 13 (2) 121-128
58 Stannard JP, Black BS, Azbell C, Volgas DA. Posteromedial corner injury in knee dislocations. J Knee Surg 2012; 25 (5) 429-434
59 Stannard JP. Medial and posteromedial instability of the knee: evaluation, treatment, and results. Sports Med Arthrosc 2010; 18 (4) 263-268
60 Arthur A, LaPrade RF, Agel J. Proximal tibial opening wedge osteotomy as the initial treatment for chronic posterolateral corner deficiency in the varus knee: a prospective clinical study. Am J Sports Med 2007; 35 (11) 1844-1850
61 Hartshorn T, Otarodifard K, White EA, Hatch III GF. Radiographic landmarks for locating the femoral origin of the superficial medial collateral ligament. Am J Sports Med 2013; 41 (11) 2527-2532
62 Wijdicks CA, Griffith CJ, LaPrade RF , et al. Radiographic identification of the primary medial knee structures. J Bone Joint Surg Am 2009; 91 (3) 521-529
63 Lind M, Jakobsen BW, Lund B, Hansen MS, Abdallah O, Christiansen SE. Anatomical reconstruction of the medial collateral ligament and posteromedial corner of the knee in patients with chronic medial collateral ligament instability. Am J Sports Med 2009; 37 (6) 1116-1122
64 Kim SJ, Lee DH, Kim TE, Choi NH. Concomitant reconstruction of the medial collateral and posterior oblique ligaments for medial instability of the knee. J Bone Joint Surg Br 2008; 90 (10) 1323-1327