Surgical Treatment of Acute Grade III Medial Collateral Ligament Injury Combined With Anterior Cruciate Ligament Injury: Anatomic Ligament Repair Versus Triangular Ligament Reconstruction.

PURPOSE: The purpose of this study was to evaluate the clinical results of medial collateral ligament (MCL) anatomic ligament repair (ALR) and triangular ligament reconstruction (TLR) in treating acute grade III MCL injury with respect to imaging and functional results. METHODS: Between January 2009 and October 2011, a total of 69 patients with an acute grade III MCL tear combined with an anterior cruciate ligament tear were divided into 2 groups: those who underwent ALR and those who underwent TLR. Single-bundle anterior cruciate ligament reconstruction was also performed in all patients. A radiographic stress-position imaging test was performed to evaluate excessive medial opening of the knee. In addition, the Slocum test was carried out to assess anteromedial rotatory instability before surgery and at follow-up. The subjective symptoms and functional outcomes were evaluated preoperatively and postoperatively with International Knee Documentation Committee (IKDC) assessment. RESULTS: Sixty-four patients with a mean follow-up period of 34 months were included in the final analysis. The measurement results for medial opening at the last follow-up appointment decreased significantly from the pretreatment measurements and fell within the normal range, without a statistically significant difference between the 2 groups (P > .05). The overall incidence of anteromedial rotatory instability was reduced to 21.9% compared with 62.5% preoperatively. However, the incidence of anteromedial rotatory instability in the TLR group (9.4%) decreased significantly compared with that in the ALR group (34.4%) (P < .05). All patients' IKDC subjective scores significantly improved after surgery. No statistically significant difference was found between the 2 groups at the last follow-up (P > .05). The comparison of IKDC extension and flexion deficit scores between the 2 groups showed no significant differences. Eleven patients in the ALR group and 4 in the TLR group complained of medial knee pain. The comparison between the 2 groups showed no significant difference (P > .05). CONCLUSIONS: The clinical outcomes of this study showed that no major difference existed in the ALR and TLR groups based on IKDC scores and medial opening evaluations in the short-term. However, TLR offered better rotatory stability than ALR at final follow-up. LEVEL OF EVIDENCE: Level II, lesser-quality randomized controlled trial.

[Comparison of efficacies for two surgical methods in the treatment of medial tibial-femoral osteoarthritis].

OBJECTIVE: To compare the clinical efficacies of two surgical methods in the treatment of medial tibial-femoral osteoarthritis. METHODS: Between October 2007 and June 2010, a total of 22 cases (25 knees) with severe osteoarthritis in medial tibial-femoral compartment underwent minimally invasive unicompartmental knee arthroplasty (UKA) with Sled prosthesis after arthroscopic procedure. And its clinical efficacy was compared with that of 22 cases (25 knees) undergoing total knee arthroplasty (TKA) with Gemini MKII prosthesis almost simultaneously. RESULTS: There were no significant difference in general data between 2 groups (P > 0.05). Compared with the TKA group, the UKA group had a smaller blood loss ((148 ± 26) vs (278 ± 36) ml), a shorter operative duration ((68 ± 12) vs (86 ± 12) min), a faster progress of resuming 90° flexion ((3.18 ± 1.8) vs (9.1 ± 2.2) d) and an earlier off-bed time (P < 0.05). All patients were followed up for 6 - 34 months. There was no significant difference in KSS (Knee Society Score), function score or WOMAC (Western Ontario and McMaster Universities) score between 2 groups at the last follow-up (P > 0.05). CONCLUSION: The treatment of medial tibial-femoral osteoarthritis with minimally invasive UKA is superior to that with TKA in that it is less invasive, there is a faster recovery of joint functions and no significant difference exists in the mid-term clinical efficacies between them.