The Journal of Bone and Joint Surgery (American). 2009;91:1305-1312.
doi:10.2106/JBJS.G.01571
© 2009 The Journal of Bone and Joint Surgery, Inc.
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Range of Motion and Quadriceps Muscle Power After Early Surgical Treatment of Acute Combined Anterior Cruciate and Grade-III Medial Collateral Ligament Injuries

A Prospective Randomized Study

Jyrki Halinen, MD1, Jan Lindahl, MD2 and Eero Hirvensalo, MD, PhD2

1 Department of Orthopedics and Traumatology, Helsinki University Central Hospital and Jorvi Hospital, Turuntie 150, 02740 Espoo, Finland. E-mail address: jyrki.halinen{at}saunalahti.fi
2 Department of Orthopaedics and Traumatology, Helsinki University Central Hospital Topeliuksenkatu 5, Helsinki PL 266, 00029 HUS Finland. E-mail address for J. Lindahl: jan.lindahl{at}hus.fi. E-mail address for E. Hirvensalo: eero.hirvensalo{at}hus.fi

Investigation performed at the Department of Orthopedics and Traumatology, Helsinki University Central Hospital, Helsinki, and Jorvi Hospital, Espoo, Finland

Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

Background: Early operative treatment of combined anterior cruciate and medial collateral ligament injuries has frequently led to motion complications and slow quadriceps muscle power gains. The purpose of the present study was to evaluate the effect of early repair or nonoperative treatment of a concomitant medial collateral ligament injury on range of motion of the knee and quadriceps muscle strength in patients with combined injuries.

Methods: Forty-seven consecutive patients with combined anterior cruciate and grade-III medial collateral ligament injuries were randomized into two groups. The medial collateral ligament was repaired in Group I (n = 23) and was treated nonoperatively in Group II (n = 24). In both groups, the torn anterior cruciate ligament was treated with early reconstruction. The patients were evaluated on the basis of sequential range-of-motion measurements, the one-leg-hop test, and isokinetic muscle power measurements at the time of follow-up, and the findings were compared between the two treatment groups.

Results: All patients achieved full knee extension. At all follow-up intervals the flexion deficit was greater in the group that had been managed with surgical repair of both ligaments, but the difference was significant only at six weeks (100° compared with 112°; p = 0.009), twelve weeks (119° compared with 128°; p = 0.043), and thirty-six weeks (130° compared with 136°; p = 0.011) after the operation. The difference between the groups was not significant at fifty-two weeks (132° compared with 137°) or 104 weeks (134° compared with 137°). The quadriceps muscle power deficit at fifty-two weeks was 30.7% in the group that had been managed with combined repair and 20.5% in the group that had been managed with anterior cruciate ligament reconstruction only (p = 0.015). At 104 weeks, the deficits were 14.4% and 9.7%, respectively (p = 0.2).

Conclusions: Early operative treatment of combined anterior cruciate and medial collateral ligament injuries is possible without increased long-term mobilization complications. The rehabilitation period is long, and aggressive physiotherapy is recommended. However, nonoperative treatment of the torn medial collateral ligament allows faster restoration of flexion and quadriceps muscle power. Our results favor nonoperative treatment of the torn medial collateral ligament in patients with combined injuries.

Level of Evidence: Therapeutic Level II. See Instructions to Authors for a complete description of levels of evidence.


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