Anatomic MCL repair, reconstruction may have equivalent radiographic outcomes
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SAN FRANCISCO — Results presented here showed anatomic-based medial collateral ligament repair and MCL reconstruction may be equivalent based on objective knee laxity, but MCL reconstruction had better subjective outcomes.
Nicholas N. DePhillipo, PhD, ATC, and colleagues randomly assigned 54 patients with grade 3 MCL tears with or without concomitant ACL injuries to undergo either an anatomic-based MCL repair technique with a hamstring tendon autograft or complete MCL reconstruction. Researchers considered valgus stress radiographs as the primary outcome variable, which were collected at 6 and 12 months postoperatively.
“A key to our study was the rehabilitation was nearly the exact same for all patients,” DePhillipo said at the Arthroscopy Association of North America Annual Meeting. “It was non-weight-bearing for 6 weeks with knee immobilizer brace and they were allowed early range of motion postoperative day 1. They were limited to flexion at 90° at 2 weeks and allowed full range of motion after.”
Valgus stress radiographs showed no significant differences between the two groups, according to DePhillipo. He said all patients improved significantly from preoperative to postoperative regardless of procedure.
“Looking at patient-reported outcomes, Lysholm and IKDC were significantly higher in the MCL reconstruction group, but there were no differences in Tegner or patient satisfaction between groups,” DePhillipo said.
He said no patients experienced major complications, such as deep venous thrombosis, infection or arthrofibrosis, and noted valgus stress radiographs showed no MCL graft failures at a minimum of 12 months postoperatively.
“We were able to corroborate our biomechanical study and show for the first time the clinical evidence to support either an MCL reconstruction or MCL repair with the use of a hamstring tendon autograft,” DePhillipo said. “However, future studies are needed to determine the superiority between the two and that could come with a number of factors, including cost effectiveness, operative time and other function and performance outcomes, such as return to play.”
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DePhillipo NN, et al. Superficial MCL augmented repair vs. reconstruction: A multicenter randomized controlled trial. Presented at: Arthroscopy Association of North America Annual Meeting. May 19-21, 2022; San Francisco.
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