Minimally Invasive Technique for the Reconstruction of the Medial Posteral Corner of the Knee associated to Anterior Cruciate Ligament. Functional Outcomes. Case Series

摘要

The medial collateral ligament (MCL) and the anterior cruciate ligament (ACL) are the most commonly damaged ligaments of the knee. These are common injuries in young people and athletes. Joint laxity may contribute to long-term cartilage degeneration in the medial compartment and give functional limitations as a result of severe lesions of ACL and MCL treated conservatively. In severe acute injuries and chronic symptomatic instabilities should be indicated surgical treatment. The anatomical technique of medial reconstruction of the knee returns stability and allows a distribution of the normal load in patients with severe or chronic acute injuries. Anatomical reconstructions require large incisions and dissections of soft tissues, favoring the risk of contracture in flexion or extension. The technique we used in our series consists of a modification of Laprade’s anatomical technique through a non-anatomical triangular medial reconstruction of the knee, using a minimally invasive approach. Objectives: Show our technique in combined injuries of medial collateral ligament and ACL. Methods: Observational study, case series, retrospective. Population of five patients (N: 5) adults of both sexes, older than 18 years, with a diagnosis of combined lesion of MCL grade II - III with clinical and subjective instability and complete rupture of ACL that have been treated surgically with an anatomical reconstruction using arthroscopic approach of the ACL and a triangular reconstruction with the modified anatomical technique of LaPrade through a minimally invasive approach by the Orthopedics and Traumatology Service of the Reina Fabiola University Clinic. A descriptive statistical analysis of the data was performed. Results: A total of five patients with an average age of 27 ± 10.89 years were included. Of the total 4 (80%) correspond to the male sex. 100% of the cases presented a grade III lesion of the MCL. Patients were followed for an average of 16 ± 9.28 months. The ROM achieved by the patients was of full extension (0°) in 100% of them and flexion in average of 130° ± 14,14. All the cases presented exceeded 100° of flexion. Pain (EVA) 0.45 / 10. The maneuvers of the internal yawn and Lachman were negative in the whole series. According to Lysholm’s functional score, there was an improvement on average of 50.40 ± 6.23 points between the preoperative evaluation, which was initially poor (40.40 ± 9.91) and the post-operative excellent (90.80 ± 4.97). All the cases in the series presented a response to treatment greater than 84 points according to the Lysholm score, with an average good to excellent result in the total. Conclusion: Although there are anatomical techniques validated for the reconstruction of the MCL, the vast majority of them involves an extensive approach with the consequent damage of soft tissues derived from it. The current trend consists of a less aggressive treatment of LCM with an associated reconstruction of the ACL. The fact of performing an anatomical reconstruction with good initial and stable fixation, minimizing soft tissue damage, aims at early rehabilitation, decreasing the chances of rigidity. We did not observe any significant limitation in the ROM, nor post-surgical rigidity in our series of patients. All of them presented a good to excellent Lysholm score and no complications were observed. This type of construct is less invasive and more practical to perform, since it uses a fixation device less than the anatomical technique of LaPrade, which reduces the cost of surgery and decreases less the bone stock, on the other hand the surgical time is not prolonged. Other advantages are that it consists of a short construct with low risk of voltage loss, with a favorable isometry and that is fast, easy to perform and reproducible.