Arthroscopy: The Journal of Arthroscopic & Related Surgery
Original ArticleThe Presence of the Arthroscopic “Floating Meniscus” Sign as an Indicator for Surgical Intervention in Patients With Combined Anterior Cruciate Ligament and Grade II Medial Collateral Ligament Injury
Section snippets
Methods
Institutional review board approval was obtained before initiation of research. A total of 196 patients with combined ACL and MCL injuries were enrolled in this randomized controlled trial between January 2004 and January 2016. The inclusion criteria for patients were as follows: (1) confirmed ACL injury, (2) patient age 16 to 65 years, (3) confirmed grade II valgus laxity during clinical examination, (4) medial compartment grade II injury confirmed by MRI, (5) normal lower limb alignment
Surgical Procedure
All ACL and MCL reconstruction surgeries were performed by the same surgeon (L.F.Z.F.) between 3 and 6 weeks after knee injury, at the same time. Direct inspection of the anteromedial structures was performed during a standard arthroscopic examination before ACL reconstruction surgery. In all cases, bone, patellar tendon, bone, or quadriceps tendon s were the graft choice for anatomic ACL reconstruction with independent femoral drilling. The grafts were fixed in the tibial and femoral tunnel
Results
Fifty-eight patients were treated with medial compartment reconstruction (group 1) and 54 with nonoperative treatment of the medial compartment (group 2). The mean age of group 1 patients was 29.7 years; group 2, 32.5 years (P < .001). Most injuries to the ACL occurred in sports that require high-intensity rotations at the knee such as soccer (55%) and jiu-jitsu (22%). A total of 62.5% of these injuries were noncontact injury mechanism, 65% of injuries occurred on the right side, and 76% on the
Discussion
The most important finding of this study was that the incidences of ACL reconstruction failure and residual MCL laxity were significantly higher in patients who underwent ACL reconstruction without medial compartment reconstruction in the presence of an arthroscopic floating meniscus sign. Additionally, Tegner and Lysholm scores were higher in patients with combined ACL-MCL grade II injuries treated with ACL and MCL reconstruction in the presence of an arthroscopic floating meniscus sign (P <
Conclusion
In the presence of a floating meniscus arthroscopic sign, patients with combined ACL and grade II MCL injuries treated with ACL and MCL reconstruction surgery had significantly lower frequency of ACL reconstruction failure, residual MCL laxity, and better Tegner and Lysholm scores at 24 months' follow-up (P < .05). Additionally, MRI and arthroscopy differed significantly (P < .05) in their ability to identify mid-substance and tibial site MCL injuries.
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Cited by (29)
Acute Percutaneous Repair of Medial Collateral Ligament With Suture Augmentation in the Multiligamentous Injured Knee Results in Good Stability and Low Rates of Postoperative Stiffness
2023, Arthroscopy, Sports Medicine, and RehabilitationTreating Combined Anterior Cruciate Ligament and Medial Collateral Ligament Injuries Operatively in the Acute Setting Is Potentially Advantageous
2023, Arthroscopy - Journal of Arthroscopic and Related SurgeryCitation Excerpt :Five studies used MCLR as treatment for at least a subset of patients,20,39,41,65,83 but open MCL repair was used in the remaining studies and was the most common procedure reported. MCL tear location was reported in 8 studies,15,20,39,41,42,44,65,84 but a standard grading method for tear location is yet to be established. Nonetheless, proximal MCL tears appeared to be the most common.
The management of combined ACL and MCL injuries: A systematic review
2022, Journal of OrthopaedicsMedial Collateral Ligament Reconstruction: A Gracilis Tenodesis for Anteromedial Knee Instability
2022, Arthroscopy TechniquesThe post-traumatic meniscal extrusion, sign of meniscotibial ligament injury. A case series
2022, Orthopaedics and Traumatology: Surgery and ResearchCitation Excerpt :In acute injury, arthroscopic diagnosis was based on direct signs such as focal area of hemorrhage, bleeding spots or a clear tear of the ligament at medial wall below the inferior surface of meniscus. In chronic injuries, presence of meniscal rise was the main indirect sign of MTL tear [12–15]. Arthroscopically, the authors considered the meniscal rise positive when the meniscus was elevated from the tibial surface for at least 2–3 mm when a valgus stress and external rotation was applied, allowing to insert a probe below the meniscal surface.
See commentary on page 938
The authors report that they have no conflicts of interest in the authorship and publication of this article. Full ICMJE author disclosure forms are available for this article online, as supplementary material.