Skip to main content
Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy 3/2010

01.03.2010 | Knee

Simultaneous surgical management of chronic grade-2 valgus instability of the knee and anterior cruciate ligament deficiency in athletes

verfasst von: Leonardo Osti, Rocco Papalia, Angelo Del Buono, Franco Merlo, Vincenzo Denaro, Nicola Maffulli

Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy | Ausgabe 3/2010

Einloggen, um Zugang zu erhalten

Abstract

We report on 22 patients with chronic grade-2 valgus laxity of the knee combined with chronic anterior cruciate ligament (ACL) insufficiency, in whom the two lesions were addressed at the same surgical setting. At a minimum follow-up of 24 months, clinical and functional variables had improved significantly (P < 0.001), and 20 of the 22 patients (91%) had returned to sport at pre-injury level. There were no operative complications in this series. In selected athletes with chronic symptomatic valgus laxity of the knee combined with ACL insufficiency, surgical repair of the MCL in association with ACL reconstruction is a suitable and reliable option to restore knee stability and allow return to pre-injury activity level.
Literatur
1.
Zurück zum Zitat Andersson C, Gillquist J (1992) Treatment of acute isolated and combined ruptures of the anterior cruciate ligament a long-term follow-up study. Am J Sports Med 20:7–12CrossRefPubMed Andersson C, Gillquist J (1992) Treatment of acute isolated and combined ruptures of the anterior cruciate ligament a long-term follow-up study. Am J Sports Med 20:7–12CrossRefPubMed
2.
Zurück zum Zitat Ballmer PM, Ballmer FT, Jakob RP (1991) Reconstruction of the anterior cruciate ligament alone in the treatment of a combined instability with complete rupture of the medial collateral ligament. A prospective study. Arch Orthop Trauma Surg 110:139–141CrossRefPubMed Ballmer PM, Ballmer FT, Jakob RP (1991) Reconstruction of the anterior cruciate ligament alone in the treatment of a combined instability with complete rupture of the medial collateral ligament. A prospective study. Arch Orthop Trauma Surg 110:139–141CrossRefPubMed
3.
Zurück zum Zitat Battaglia MJ II, Lenhoff MW, Ehteshami JR, Lyman S, Provencher MT, Wickiewicz TL, Warren RF (2009) Medial collateral ligament injuries and subsequent load on the anterior cruciate ligament: a biomechanical evaluation in a cadaveric model. Am J Sports Med 37:305–311CrossRefPubMed Battaglia MJ II, Lenhoff MW, Ehteshami JR, Lyman S, Provencher MT, Wickiewicz TL, Warren RF (2009) Medial collateral ligament injuries and subsequent load on the anterior cruciate ligament: a biomechanical evaluation in a cadaveric model. Am J Sports Med 37:305–311CrossRefPubMed
4.
Zurück zum Zitat Cameron ML, Briggs KK, Steadman JR (2003) Reproducibility and reliability of the outerbridge classification for grading chondral lesions of the knee arthroscopically. Am J Sports Med 31:83–86PubMed Cameron ML, Briggs KK, Steadman JR (2003) Reproducibility and reliability of the outerbridge classification for grading chondral lesions of the knee arthroscopically. Am J Sports Med 31:83–86PubMed
5.
Zurück zum Zitat Chen L, Kim PD, Ahmad CS, Levine WN (2008) Medial collateral ligament injuries of the knee: current treatment concepts. Curr Rev Musculoskelet Med 1:108–113CrossRefPubMed Chen L, Kim PD, Ahmad CS, Levine WN (2008) Medial collateral ligament injuries of the knee: current treatment concepts. Curr Rev Musculoskelet Med 1:108–113CrossRefPubMed
6.
Zurück zum Zitat Daniel DM, Malcom LL, Losse G, Stone ML, Sachs R, Burks R (1985) Instrumented measurement of anterior laxity of the knee. J Bone Joint Surg Am 67:720–726PubMed Daniel DM, Malcom LL, Losse G, Stone ML, Sachs R, Burks R (1985) Instrumented measurement of anterior laxity of the knee. J Bone Joint Surg Am 67:720–726PubMed
7.
Zurück zum Zitat Fetto JF, Marshall JL (1978) Medial collateral ligament injuries of the knee: a rationale for treatment. Clin Orthop Relat Res 132:206–218PubMed Fetto JF, Marshall JL (1978) Medial collateral ligament injuries of the knee: a rationale for treatment. Clin Orthop Relat Res 132:206–218PubMed
8.
Zurück zum Zitat Fetto JF, Marshall JL (1979) Injury to the anterior cruciate ligament producing the pivot-shift sign. J Bone Joint Surg Am 61:710–714PubMed Fetto JF, Marshall JL (1979) Injury to the anterior cruciate ligament producing the pivot-shift sign. J Bone Joint Surg Am 61:710–714PubMed
9.
Zurück zum Zitat Fukuda Y, Woo SL, Loh JC, Tsuda E, Tang P, McMahon PJ, Debski RE (2003) A quantitative analysis of valgus torque on the ACL: a human cadaveric study. J Orthop Res 21:1107–1112CrossRefPubMed Fukuda Y, Woo SL, Loh JC, Tsuda E, Tang P, McMahon PJ, Debski RE (2003) A quantitative analysis of valgus torque on the ACL: a human cadaveric study. J Orthop Res 21:1107–1112CrossRefPubMed
10.
Zurück zum Zitat Gobbi A, Bathan L, Boldrini L (2009) Primary repair combined with bone marrow stimulation in acute anterior cruciate ligament lesions: results in a group of athletes. Am J Sports Med 37:571–578CrossRefPubMed Gobbi A, Bathan L, Boldrini L (2009) Primary repair combined with bone marrow stimulation in acute anterior cruciate ligament lesions: results in a group of athletes. Am J Sports Med 37:571–578CrossRefPubMed
11.
Zurück zum Zitat Gougoulias N, Khanna A, Griffiths D, Maffulli N (2008) ACL reconstruction: can the transtibial technique achieve optimal tunnel positioning? A radiographic study. Knee 15:486–490CrossRefPubMed Gougoulias N, Khanna A, Griffiths D, Maffulli N (2008) ACL reconstruction: can the transtibial technique achieve optimal tunnel positioning? A radiographic study. Knee 15:486–490CrossRefPubMed
12.
Zurück zum Zitat Hara K, Niga S, Ikeda H, Cho S, Muneta T (2008) Isolated anterior cruciate ligament reconstruction in patients with chronic anterior cruciate ligament insufficiency combined with grade II valgus laxity. Am J Sports Med 36:333–339CrossRefPubMed Hara K, Niga S, Ikeda H, Cho S, Muneta T (2008) Isolated anterior cruciate ligament reconstruction in patients with chronic anterior cruciate ligament insufficiency combined with grade II valgus laxity. Am J Sports Med 36:333–339CrossRefPubMed
13.
Zurück zum Zitat Hayashi R, Kitamura N, Kondo E, Anaguchi Y, Tohyama H, Yasuda K (2008) Simultaneous anterior and posterior cruciate ligament reconstruction in chronic knee instabilities: surgical concepts and clinical outcome. Knee Surg Sports Traumatol Arthrosc 16:763–769CrossRefPubMed Hayashi R, Kitamura N, Kondo E, Anaguchi Y, Tohyama H, Yasuda K (2008) Simultaneous anterior and posterior cruciate ligament reconstruction in chronic knee instabilities: surgical concepts and clinical outcome. Knee Surg Sports Traumatol Arthrosc 16:763–769CrossRefPubMed
14.
Zurück zum Zitat Hefti F, Muller W, Jakob RP, Staubli HU (1993) Evaluation of knee ligament injuries with the IKDC form. Knee Surg Sports Traumatol Arthrosc 1:226–234CrossRefPubMed Hefti F, Muller W, Jakob RP, Staubli HU (1993) Evaluation of knee ligament injuries with the IKDC form. Knee Surg Sports Traumatol Arthrosc 1:226–234CrossRefPubMed
15.
Zurück zum Zitat Hughston JC, Andrews JR, Cross MJ, Moschi A (1976) Classification of knee ligament instabilities. Part I. The medial compartment and cruciate ligaments. J Bone Joint Surg Am 58:159–172PubMed Hughston JC, Andrews JR, Cross MJ, Moschi A (1976) Classification of knee ligament instabilities. Part I. The medial compartment and cruciate ligaments. J Bone Joint Surg Am 58:159–172PubMed
16.
Zurück zum Zitat Indelicato PA (1983) Non-operative treatment of complete tears of the medial collateral ligament of the knee. J Bone Joint Surg Am 65:323–329PubMed Indelicato PA (1983) Non-operative treatment of complete tears of the medial collateral ligament of the knee. J Bone Joint Surg Am 65:323–329PubMed
17.
Zurück zum Zitat Jacobson KE, Chi FS (2006) Evaluation and treatment of medial collateral ligament and medial-sided injuries of the knee. Sports Med Arthrosc 14:58–66CrossRefPubMed Jacobson KE, Chi FS (2006) Evaluation and treatment of medial collateral ligament and medial-sided injuries of the knee. Sports Med Arthrosc 14:58–66CrossRefPubMed
18.
Zurück zum Zitat Krackow KA, Thomas SC, Jones LC (1986) A new stitch for ligament-tendon fixation. Brief note. J Bone Joint Surg Am 68:764–766PubMed Krackow KA, Thomas SC, Jones LC (1986) A new stitch for ligament-tendon fixation. Brief note. J Bone Joint Surg Am 68:764–766PubMed
19.
Zurück zum Zitat Larson RL (1980) Combined instabilities of the knee. Clin Orthop Relat Res 147:68–75PubMed Larson RL (1980) Combined instabilities of the knee. Clin Orthop Relat Res 147:68–75PubMed
20.
Zurück zum Zitat Ma CB, Papageogiou CD, Debski RE, Woo SL (2000) Interaction between the ACL graft and MCL in a combined ACL + MCL knee injury using a goat model. Acta Orthop Scand 71:387–393PubMedCrossRef Ma CB, Papageogiou CD, Debski RE, Woo SL (2000) Interaction between the ACL graft and MCL in a combined ACL + MCL knee injury using a goat model. Acta Orthop Scand 71:387–393PubMedCrossRef
21.
Zurück zum Zitat Markolf KL, Mensch JS, Amstutz HC (1976) Stiffness and laxity of the knee—the contributions of the supporting structures. A quantitative in vitro study. J Bone Joint Surg Am 58:583–594PubMed Markolf KL, Mensch JS, Amstutz HC (1976) Stiffness and laxity of the knee—the contributions of the supporting structures. A quantitative in vitro study. J Bone Joint Surg Am 58:583–594PubMed
22.
Zurück zum Zitat McKeon BP, Heming JF, Fulkerson J, Langeland R (2006) The Krackow stitch: a biomechanical evaluation of changing the number of loops versus the number of sutures. Arthroscopy 22:33–37PubMed McKeon BP, Heming JF, Fulkerson J, Langeland R (2006) The Krackow stitch: a biomechanical evaluation of changing the number of loops versus the number of sutures. Arthroscopy 22:33–37PubMed
23.
Zurück zum Zitat Melegati G, Tornese D, Bandi M, Volpi P, Schonhuber H, Denti M (2003) The role of the rehabilitation brace in restoring knee extension after anterior cruciate ligament reconstruction: a prospective controlled study. Knee Surg Sports Traumatol Arthrosc 11:322–326CrossRefPubMed Melegati G, Tornese D, Bandi M, Volpi P, Schonhuber H, Denti M (2003) The role of the rehabilitation brace in restoring knee extension after anterior cruciate ligament reconstruction: a prospective controlled study. Knee Surg Sports Traumatol Arthrosc 11:322–326CrossRefPubMed
24.
Zurück zum Zitat Miyasaka KC, Daniel DM, Stone ML, Hirshman P (1991) The incidence of knee ligament injuries in the general population. Am J Knee Surg 4:3–8 Miyasaka KC, Daniel DM, Stone ML, Hirshman P (1991) The incidence of knee ligament injuries in the general population. Am J Knee Surg 4:3–8
25.
Zurück zum Zitat Mok DW, Good C (1989) Non-operative management of acute grade III medial collateral ligament injury of the knee: a prospective study. Injury 20:277–280CrossRefPubMed Mok DW, Good C (1989) Non-operative management of acute grade III medial collateral ligament injury of the knee: a prospective study. Injury 20:277–280CrossRefPubMed
26.
Zurück zum Zitat Ohno K, Pomaybo AS, Schmidt CC, Levine RE, Ohland KJ, Woo SL (1995) Healing of the medial collateral ligament after a combined medial collateral and anterior cruciate ligament injury and reconstruction of the anterior cruciate ligament: comparison of repair and nonrepair of medial collateral ligament tears in rabbits. J Orthop Res 13:442–449CrossRefPubMed Ohno K, Pomaybo AS, Schmidt CC, Levine RE, Ohland KJ, Woo SL (1995) Healing of the medial collateral ligament after a combined medial collateral and anterior cruciate ligament injury and reconstruction of the anterior cruciate ligament: comparison of repair and nonrepair of medial collateral ligament tears in rabbits. J Orthop Res 13:442–449CrossRefPubMed
27.
Zurück zum Zitat Petersen W, Laprell H (1999) Combined injuries of the medial collateral ligament and the anterior cruciate ligament. Early ACL reconstruction versus late ACL reconstruction. Arch Orthop Trauma Surg 119:258–262CrossRefPubMed Petersen W, Laprell H (1999) Combined injuries of the medial collateral ligament and the anterior cruciate ligament. Early ACL reconstruction versus late ACL reconstruction. Arch Orthop Trauma Surg 119:258–262CrossRefPubMed
28.
Zurück zum Zitat Phisitkul P, James SL, Wolf BR, Amendola A (2006) MCL injuries of the knee: current concepts review. Iowa Orthop J 26:77–90PubMed Phisitkul P, James SL, Wolf BR, Amendola A (2006) MCL injuries of the knee: current concepts review. Iowa Orthop J 26:77–90PubMed
29.
Zurück zum Zitat Seon JK, Gadikota HR, Kozanek M, Oh LS, Gill TJ, Li G (2009) The effect of anterior cruciate ligament reconstruction on kinematics of the knee with combined anterior cruciate ligament injury and subtotal medial meniscectomy: an in vitro robotic investigation. Arthroscopy 25:123–130PubMed Seon JK, Gadikota HR, Kozanek M, Oh LS, Gill TJ, Li G (2009) The effect of anterior cruciate ligament reconstruction on kinematics of the knee with combined anterior cruciate ligament injury and subtotal medial meniscectomy: an in vitro robotic investigation. Arthroscopy 25:123–130PubMed
30.
Zurück zum Zitat Shelbourne KD, Patel DV (1996) Management of combined injuries of the anterior cruciate and medial collateral ligaments. Instr Course Lect 45:275–280PubMed Shelbourne KD, Patel DV (1996) Management of combined injuries of the anterior cruciate and medial collateral ligaments. Instr Course Lect 45:275–280PubMed
31.
Zurück zum Zitat Shelbourne KD, Porter DA (1992) 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 20:283–286CrossRefPubMed Shelbourne KD, Porter DA (1992) 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 20:283–286CrossRefPubMed
32.
Zurück zum Zitat Shelbourne KD, Vanadurongwan B, Gray T (2007) Primary anterior cruciate ligament reconstruction using contralateral patellar tendon autograft. Clin Sports Med 26:549–565CrossRefPubMed Shelbourne KD, Vanadurongwan B, Gray T (2007) Primary anterior cruciate ligament reconstruction using contralateral patellar tendon autograft. Clin Sports Med 26:549–565CrossRefPubMed
33.
Zurück zum Zitat Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 198:43–49PubMed Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 198:43–49PubMed
34.
Zurück zum Zitat Torg JS, Conrad W, Kalen V (1976) Clinical diagnosis of anterior cruciate ligament instability in the athlete. Am J Sports Med 4:84–93CrossRefPubMed Torg JS, Conrad W, Kalen V (1976) Clinical diagnosis of anterior cruciate ligament instability in the athlete. Am J Sports Med 4:84–93CrossRefPubMed
35.
Zurück zum Zitat Warren LA, Marshall JL, Girgis F (1974) The prime static stabilizer of the medical side of the knee. J Bone Joint Surg Am 56:665–674PubMed Warren LA, Marshall JL, Girgis F (1974) The prime static stabilizer of the medical side of the knee. J Bone Joint Surg Am 56:665–674PubMed
36.
Zurück zum Zitat Woo SL, Vogrin TM, Abramowitch SD (2000) Healing and repair of ligament injuries in the knee. J Am Acad Orthop Surg 8:364–372PubMed Woo SL, Vogrin TM, Abramowitch SD (2000) Healing and repair of ligament injuries in the knee. J Am Acad Orthop Surg 8:364–372PubMed
37.
Zurück zum Zitat Wright RW, Parikh M, Allen T, Brodt MD, Silva MJ, Botney MD (2003) Effect of hemorrhage on medial collateral ligament healing in a mouse model. Am J Sports Med 31:660–666PubMed Wright RW, Parikh M, Allen T, Brodt MD, Silva MJ, Botney MD (2003) Effect of hemorrhage on medial collateral ligament healing in a mouse model. Am J Sports Med 31:660–666PubMed
38.
Zurück zum Zitat Zaffagnini S, Bignozzi S, Martelli S, Lopomo N, Marcacci M (2007) Does ACL reconstruction restore knee stability in combined lesions? An in vivo study. Clin Orthop Relat Res 454:95–99CrossRefPubMed Zaffagnini S, Bignozzi S, Martelli S, Lopomo N, Marcacci M (2007) Does ACL reconstruction restore knee stability in combined lesions? An in vivo study. Clin Orthop Relat Res 454:95–99CrossRefPubMed
Metadaten
Titel
Simultaneous surgical management of chronic grade-2 valgus instability of the knee and anterior cruciate ligament deficiency in athletes
verfasst von
Leonardo Osti
Rocco Papalia
Angelo Del Buono
Franco Merlo
Vincenzo Denaro
Nicola Maffulli
Publikationsdatum
01.03.2010
Verlag
Springer-Verlag
Erschienen in
Knee Surgery, Sports Traumatology, Arthroscopy / Ausgabe 3/2010
Print ISSN: 0942-2056
Elektronische ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-009-0966-y

Weitere Artikel der Ausgabe 3/2010

Knee Surgery, Sports Traumatology, Arthroscopy 3/2010 Zur Ausgabe

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen. 
» Jetzt entdecken

TEP mit Roboterhilfe führt nicht zu größerer Zufriedenheit

15.05.2024 Knie-TEP Nachrichten

Der Einsatz von Operationsrobotern für den Einbau von Totalendoprothesen des Kniegelenks hat die Präzision der Eingriffe erhöht. Für die postoperative Zufriedenheit der Patienten scheint das aber unerheblich zu sein, wie eine Studie zeigt.

Lever-Sign-Test hilft beim Verdacht auf Kreuzbandriss

15.05.2024 Vordere Kreuzbandruptur Nachrichten

Mit dem Hebelzeichen-Test lässt sich offenbar recht zuverlässig feststellen, ob ein vorderes Kreuzband gerissen ist. In einer Metaanalyse war die Vorhersagekraft vor allem bei positivem Testergebnis hoch.

Ein Drittel der jungen Ärztinnen und Ärzte erwägt abzuwandern

07.05.2024 Klinik aktuell Nachrichten

Extreme Arbeitsverdichtung und kaum Supervision: Dr. Andrea Martini, Sprecherin des Bündnisses Junge Ärztinnen und Ärzte (BJÄ) über den Frust des ärztlichen Nachwuchses und die Vorteile des Rucksack-Modells.

Aquatherapie bei Fibromyalgie wirksamer als Trockenübungen

03.05.2024 Fibromyalgiesyndrom Nachrichten

Bewegungs-, Dehnungs- und Entspannungsübungen im Wasser lindern die Beschwerden von Patientinnen mit Fibromyalgie besser als das Üben auf trockenem Land. Das geht aus einer spanisch-brasilianischen Vergleichsstudie hervor.

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.