D. Hillardsembell et al., COMBINED INJURIES OF THE ANTERIOR CRUCIATE AND MEDIAL COLLATERAL LIGAMENTS OF THE KNEE - EFFECT OF TREATMENT ON STABILITY AND FUNCTION OF THE JOINT, Journal of bone and joint surgery. American volume, 78A(2), 1996, pp. 169-176
We performed a retrospective study of sixty-six patients (forty-one ma
le and twenty-five female) who had a combined injury of the anterior c
ruciate and medial collateral ligaments, Our purpose was to determine
the prevalence of late valgus instability of the knee, The mean age of
the patients was thirty-five years (range, sixteen to sixty-three yea
rs), The mean follow-up interval was forty-five months (range, twenty-
one to 108 months), Twenty patients had been injured while snow-skiing
; twenty-four, during other sports activities; seven, in a motor-vehic
le accident; and the remaining fifteen, during activities of daily liv
ing, Eleven patients had reconstruction of the anterior cruciate ligam
ent and repair of the medial collateral ligament, thirty-three had rec
onstruction of only the anterior cruciate ligament, and twenty-two wer
e managed non-operatively. There was no evidence of valgus instability
on clinical examination at the most recent follow-up visit, However,
there was evidence of instability on stress roentgenograms of the knee
in eight (13 per cent) of sixty patients, With the numbers available,
we could detect no relationship between the presence of valgus instab
ility and the method of treatment of the ligamentous tears (p > 0.4).
We also compared the results for twenty-one of the thirty-three patien
ts who had a combined ligamentous injury and reconstruction of only th
e anterior cruciate ligament with those for thirty-seven patients who
had reconstruction of an isolated tear of the anterior cruciate ligame
nt, After a mean follow-up interval of thirty-five months (range, twen
ty-one to sixty-six months), there was no difference in the anterior d
isplacement, impairment of function, level of participation in sports
activities, results of the one-leg-hop for distance test, or strength
as determined by testing on a Cybex machine. On the basis of the findi
ngs in this study, we believe that, when there is mild or moderate val
gus instability, an injury of the medial collateral ligament does not
need to be repaired when the anterior cruciate ligament is repaired af
ter a combined ligamentous injury.