Treatment of medial-sided injuries in patients with early bicruciate ligament reconstruction for knee dislocation
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KNEE
Treatment of medial‑sided injuries in patients with early bicruciate ligament reconstruction for knee dislocation Mikko A. Jokela1,3,4 · Tatu J. Mäkinen1,3 · Mika P. Koivikko2,3 · Joonas M. Lindahl3 · Jyrki Halinen4 · Jan Lindahl1,3 Received: 26 March 2020 / Accepted: 3 August 2020 © The Author(s) 2020
Abstract Purpose In knee dislocation with bicruciate ligament and medial side injury (KDIIIM), treatment method of medial side injuries is controversial. The purpose of this study was to evaluate the outcomes of non-operative treatment of proximal and midsubstance and operative treatment of distal avulsion medial collateral ligament (MCL) ruptures in patients with early bicruciate reconstruction. Methods One-hundred and forty-seven patients with a knee dislocation and bicruciate ligament injury (KDII-KDV) were identified. Sixty-two patients had KDIIIM injury. Of these, 24 patients were excluded and 13 were lost to follow-up. With a minimum of 2 years of follow-up, IKDC2000 (subjective and objective), Lysholm and Tegner scores and stress radiographs were recorded. Results Twenty-five patients were available for follow-up: 18 had a proximal or midsubstance grade-III MCL rupture (proximal MCL group) and 7 had a distal MCL avulsion (distal MCL group). In the proximal MCL and distal MCL groups, respectively, median IKDC2000 subjective scores were 80 (range 57–99) and 62 (range 39–87), and median Lysholm scores were 88 (range 57–99) and 75 (range 40–100). The median medial opening (side-to-side difference) was 2.4 mm (range 0.1–9.2) in the proximal MCL group and 2.5 mm (range 0.2–4.8) in the distal MCL group. Conclusion We found acceptable recorded outcomes in patients who underwent non-operative treatment of proximal and midsubstance grade-III MCL rupture and operative treatment of distal MCL avulsion with early bicruciate ligament reconstruction. Level of evidence Level IV Keywords Knee multiligament injury · Knee dislocation · KDIIIM · Knee posteromedial corner injury · Bicruciate ligament injury · Medial side injury
Introduction Knee dislocation is a rare injury typically caused by highenergy trauma, but it can occur with low-energy insult during sports or even in a same-level fall [37]. Knee dislocation
* Mikko A. Jokela [email protected] 1
Department of Orthopaedics and Traumatology, Töölö Hospital, Helsinki University Hospital, Helsinki, Finland
2
Department of Radiology, Helsinki Medical Imaging Center, Töölö Hospital, Helsinki University Hospital, Helsinki, Finland
3
University of Helsinki, Helsinki, Finland
4
Terveystalo Hospital, Helsinki, Finland
leads most often to the complete rupture of both the anterior and posterior cruciate ligaments (ACL and PCL, respectively), and rupture of both cruciates thus could be considered a type of knee dislocation [36]. Concomitant medial side ligamentous injuries are often present in knee dislocations [20]. The main structures medial to the knee joint are the proximal and distal divisions of the superficial medial collateral ligament (
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