Association of medial collateral ligament complex injuries with anterior cruciate ligament ruptures based on posterolateral tibial plateau injuries
Abstract Background The combined injury of the medial collateral ligament complex and the anterior cruciate ligament (ACL) is the most common two ligament injury of the knee. Additional injuries to the medial capsuloligamentous structures are associated with rotational instability and a high failure...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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SpringerOpen
2023-08-01
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| Series: | Sports Medicine - Open |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s40798-023-00611-6 |
| _version_ | 1797559447305846784 |
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| author | Fidelius Von Rehlingen-Prinz Miriam Leiderer Julius Dehoust Tobias Dust Birgitt Kowald Karl-Heinz Frosch Kaywan Izadpanah Frank Oliver Henes Matthias Krause |
| author_facet | Fidelius Von Rehlingen-Prinz Miriam Leiderer Julius Dehoust Tobias Dust Birgitt Kowald Karl-Heinz Frosch Kaywan Izadpanah Frank Oliver Henes Matthias Krause |
| author_sort | Fidelius Von Rehlingen-Prinz |
| collection | DOAJ |
| description | Abstract Background The combined injury of the medial collateral ligament complex and the anterior cruciate ligament (ACL) is the most common two ligament injury of the knee. Additional injuries to the medial capsuloligamentous structures are associated with rotational instability and a high failure rate of ACL reconstruction. The study aimed to analyze the specific pattern of medial injuries and their associated risk factors, with the goal of enabling early diagnosis and initiating appropriate therapeutic interventions, if necessary. Results Between January 2017 and December 2018, 151 patients with acute ACL ruptures with a mean age of 32 ± 12 years were included in this study. The MRIs performed during the acute phase were analyzed by four independent investigators—two radiologists and two orthopedic surgeons. The trauma impact on the posterolateral tibial plateau and associated injuries to the medial complex (POL, dMCL, and sMCL) were examined and revealed an injury to the medial collateral ligament complex in 34.4% of the patients. The dMCL was the most frequently injured structure (92.2%). A dMCL injury was significantly associated with an increase in trauma severity at the posterolateral tibial plateau (p < 0.02) and additional injuries to the sMCL (OR 4.702, 95% CL 1.3–133.3, p = 0.03) and POL (OR 20.818, 95% CL 5.9–84.4, p < 0.0001). Isolated injuries to the sMCL were not observed. Significant risk factors for acquiring an sMCL injury were age (p < 0.01) and injury to the lateral meniscus (p < 0.01). Conclusion In about one-third of acute ACL ruptures the medial collateral ligament complex is also injured. This might be associated with an increased knee laxity as well as anteromedial rotational instability. Also, this might be associated with an increased risk for failure of revision ACL reconstruction. In addition, we show risk factors and predictors that point to an injury of medial structures and facilitate their diagnosis. This should help physicians and surgeons to precisely diagnose and to assess its scope in order to initiate proper therapies. With this in mind, we would like to draw attention to a frequently occurring combination injury, the so-called “unlucky triad” (ACL, MCL, and lateral meniscus). Level of evidence Level III Retrospective cohort study. |
| first_indexed | 2024-03-10T17:45:34Z |
| format | Article |
| id | doaj.art-08799eeb64654b7e8f3c263068ad13a2 |
| institution | Directory Open Access Journal |
| issn | 2198-9761 |
| language | English |
| last_indexed | 2024-03-10T17:45:34Z |
| publishDate | 2023-08-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Sports Medicine - Open |
| spelling | doaj.art-08799eeb64654b7e8f3c263068ad13a22023-11-20T09:32:23ZengSpringerOpenSports Medicine - Open2198-97612023-08-01911910.1186/s40798-023-00611-6Association of medial collateral ligament complex injuries with anterior cruciate ligament ruptures based on posterolateral tibial plateau injuriesFidelius Von Rehlingen-Prinz0Miriam Leiderer1Julius Dehoust2Tobias Dust3Birgitt Kowald4Karl-Heinz Frosch5Kaywan Izadpanah6Frank Oliver Henes7Matthias Krause8Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-EppendorfDepartment of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-EppendorfDepartment of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Hospital HamburgDepartment of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-EppendorfDepartment of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Hospital HamburgDepartment of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-EppendorfDepartment of Orthopaedic and Trauma Surgery, University Medical Center FreiburgDepartment of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-EppendorfDepartment of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-EppendorfAbstract Background The combined injury of the medial collateral ligament complex and the anterior cruciate ligament (ACL) is the most common two ligament injury of the knee. Additional injuries to the medial capsuloligamentous structures are associated with rotational instability and a high failure rate of ACL reconstruction. The study aimed to analyze the specific pattern of medial injuries and their associated risk factors, with the goal of enabling early diagnosis and initiating appropriate therapeutic interventions, if necessary. Results Between January 2017 and December 2018, 151 patients with acute ACL ruptures with a mean age of 32 ± 12 years were included in this study. The MRIs performed during the acute phase were analyzed by four independent investigators—two radiologists and two orthopedic surgeons. The trauma impact on the posterolateral tibial plateau and associated injuries to the medial complex (POL, dMCL, and sMCL) were examined and revealed an injury to the medial collateral ligament complex in 34.4% of the patients. The dMCL was the most frequently injured structure (92.2%). A dMCL injury was significantly associated with an increase in trauma severity at the posterolateral tibial plateau (p < 0.02) and additional injuries to the sMCL (OR 4.702, 95% CL 1.3–133.3, p = 0.03) and POL (OR 20.818, 95% CL 5.9–84.4, p < 0.0001). Isolated injuries to the sMCL were not observed. Significant risk factors for acquiring an sMCL injury were age (p < 0.01) and injury to the lateral meniscus (p < 0.01). Conclusion In about one-third of acute ACL ruptures the medial collateral ligament complex is also injured. This might be associated with an increased knee laxity as well as anteromedial rotational instability. Also, this might be associated with an increased risk for failure of revision ACL reconstruction. In addition, we show risk factors and predictors that point to an injury of medial structures and facilitate their diagnosis. This should help physicians and surgeons to precisely diagnose and to assess its scope in order to initiate proper therapies. With this in mind, we would like to draw attention to a frequently occurring combination injury, the so-called “unlucky triad” (ACL, MCL, and lateral meniscus). Level of evidence Level III Retrospective cohort study.https://doi.org/10.1186/s40798-023-00611-6Anteromedial rotatory instabilityMedial collateral ligament complexDeep MCLMagnetic resonance imagingAnterior cruciate ligament injury |
| spellingShingle | Fidelius Von Rehlingen-Prinz Miriam Leiderer Julius Dehoust Tobias Dust Birgitt Kowald Karl-Heinz Frosch Kaywan Izadpanah Frank Oliver Henes Matthias Krause Association of medial collateral ligament complex injuries with anterior cruciate ligament ruptures based on posterolateral tibial plateau injuries Sports Medicine - Open Anteromedial rotatory instability Medial collateral ligament complex Deep MCL Magnetic resonance imaging Anterior cruciate ligament injury |
| title | Association of medial collateral ligament complex injuries with anterior cruciate ligament ruptures based on posterolateral tibial plateau injuries |
| title_full | Association of medial collateral ligament complex injuries with anterior cruciate ligament ruptures based on posterolateral tibial plateau injuries |
| title_fullStr | Association of medial collateral ligament complex injuries with anterior cruciate ligament ruptures based on posterolateral tibial plateau injuries |
| title_full_unstemmed | Association of medial collateral ligament complex injuries with anterior cruciate ligament ruptures based on posterolateral tibial plateau injuries |
| title_short | Association of medial collateral ligament complex injuries with anterior cruciate ligament ruptures based on posterolateral tibial plateau injuries |
| title_sort | association of medial collateral ligament complex injuries with anterior cruciate ligament ruptures based on posterolateral tibial plateau injuries |
| topic | Anteromedial rotatory instability Medial collateral ligament complex Deep MCL Magnetic resonance imaging Anterior cruciate ligament injury |
| url | https://doi.org/10.1186/s40798-023-00611-6 |
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