Summary
The overall combined prevalence of MCL (sMCL and dMCL) and isolated dMCL injuries in patients with ACL tears was high (16.5% + 24.8% = 41.3%). LM injuries and LFC impaction increased the odds, whereas the presence of a MM injury reduced the odds of having an MCL injury.
Abstract
Purpose
To assess the prevalence of and factors associated with medial collateral ligament MCL complex injuries in patients with anterior cruciate ligament (ACL) tears.
Methods
Data were extracted from the Natural Corollaries and Recovery after ACL injury multicenter longitudinal cohort (NACOX) study. All patients included in the study underwent magnetic resonance imaging (MRI). Time from injury to MRI was 19.6 ± 15.2 days. An orthopaedic surgeon specializing in knee surgery and a musculoskeletal radiologist reviewed all MRI scans. Injuries to the superficial MCL (sMCL) and deep MCL (dMCL) were identified. Stepwise forward multiple binary logistic regression analyses were used to evaluate patient characteristics (age, sex, body mass index, pre-injury Tegner activity level, activity at injury) and MRI injuries (lateral meniscus [LM], medial meniscus [MM], pivot-shift bone bruising, medial femoral condyle [MFC] bone bruising and lateral femoral condyle [LFC] impaction) associated with the presence of MCL complex tears.
Results
In total, 254 patients (48.4% males) with a mean age of 25.4 ± 7.1 years were included. The overall prevalence of MCL (sMCL and dMCL) and isolated dMCL injuries was 16.5% (42/254) and 24.8% (63/254) respectively. No isolated sMCL injuries were found. LM injury [odds ratio (OR) 3.94; 95% confidence intervals (CI) 1.73 – 8.94; P = 0.001] and LFC impaction (OR 2.37; 95% CI 1.11 – 5.07; P = 0.02) increased the odds, whereas MM injury (OR 0.26; 95% CI 0.12 – 0.59; P = 0.001) reduced the odds of having an MCL injury. Isolated dMCL injuries were significantly associated with MFC bone bruising (OR 4.21; 95% CI 1.92 – 9.25; P < 0.001) and LFC impaction (OR 3.86; 95% CI 1.99 – 7.49; P < 0.001).
Conclusion
The overall combined prevalence of MCL (sMCL and dMCL) and isolated dMCL injuries in patients with ACL tears was high (16.5% + 24.8% = 41.3%). LM injuries and LFC impaction increased the odds, whereas the presence of a MM injury reduced the odds of having an MCL injury. MFC bone bruising and LFC impaction were associated with the presence of isolated dMCL injuries. This study provides surgeons and radiologists with important information regarding the prevalence and factors associated with MCL and isolated dMCL injuries and may, therefore, facilitate their diagnosis and treatment in patients with ACL tears.
Level of evidence Level III, retrospective cohort study.
IRB
Ethical approval was obtained by the regional ethics committee in Linköping, Sweden (Dnr 2016/44-31 and 2017/221-32). All patients signed informed consent to participate.
Acknowledgements:
This study is part of the NACOX-cohort, a project investigating the natural corollaries and recovery after acute ACL injury. We would like to thank all collaborators in the NACOX study and Henrik Hedevik for his contribution to data management. The NACOX-cohort study is supported by the Swedish Research Council, the Swedish Research Council for Sport Science, the Medical Research Council of Southeast, and ALF Grants Region Östergötland