Evidence map›Paper›PMID 33661325›Full record

ArticleKnee surgery, sports traumatology, arthroscopy : official journal of the ESSKA2022

High incidence of superficial and deep medial collateral ligament injuries in 'isolated' anterior cruciate ligament ruptures: a long overlooked injury.

Lukas Willinger, Ganesh Balendra, Vishal Pai, Justin Lee, Adam Mitchell, Mary Jones, Andy Williams

Open access · hybridAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 69 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
69citing papers in PubMed, 1 pooled it
13.8field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

69 citing papers in PubMed, 1 synthesis or guideline pooled it, 100 citations in OpenAlex.

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9 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors at 2 institutions in 2 countries.

Lukas WillingerDepartment of Trauma and Orthopaedics, Chelsea and Westminster Hospital, Chelsea and Westminster NHS Foundation Trust, London, UK.
Ganesh BalendraFortius Clinic, 17 Fitzhardinge St, London, W1H 6EQ, UK.
Vishal PaiFortius Clinic, 17 Fitzhardinge St, London, W1H 6EQ, UK.
Justin LeeFortius Clinic, 17 Fitzhardinge St, London, W1H 6EQ, UK.
Adam MitchellFortius Clinic, 17 Fitzhardinge St, London, W1H 6EQ, UK.
Mary JonesFortius Clinic, 17 Fitzhardinge St, London, W1H 6EQ, UK.
Andy WilliamsFortius Clinic, 17 Fitzhardinge St, London, W1H 6EQ, UK. williams@fortiusclinic.com.
Fortius Clinic · GBChelsea and Westminster Hospital NHS Foundation Trust · GB

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeIn anterior cruciate ligament (ACL) injuries, concomitant damage to peripheral soft tissues is associated with increased rotatory instability of the knee. The purpose of this study was to investigate the incidence and patterns of medial collateral ligament complex injuries in patients with clinically 'isolated' ACL ruptures.

methodsPatients who underwent ACL reconstruction for complete 'presumed isolated' ACL rupture between 2015 and 2019 were retrospectively included in this study. Patient's characteristics and intraoperative findings were retrieved from clinical and surgical documentation. Preoperative MRIs were evaluated and the grade and location of injuries to the superficial MCL (sMCL), dMCL and the posterior oblique ligament (POL) recorded. All patients were clinically assessed under anaesthesia with standard ligament laxity tests.

resultsHundred patients with a mean age of 22.3 ± 4.9 years were included. The incidence of concomitant MCL complex injuries was 67%. sMCL injuries occurred in 62%, dMCL in 31% and POL in 11% with various injury patterns. A dMCL injury was significantly associated with MRI grade II sMCL injuries, medial meniscus 'ramp' lesions seen at surgery and bone oedema at the medial femoral condyle (MFC) adjacent to the dMCL attachment site (p < 0.01). Logistic regression analysis identified younger age (OR 1.2, p < 0.05), simultaneous sMCL injury (OR 6.75, p < 0.01) and the presence of bone oedema at the MFC adjacent to the dMCL attachment site (OR 5.54, p < 0.01) as predictive factors for a dMCL injury.

conclusionThe incidence of combined ACL and medial ligament complex injuries is high. Lesions of the dMCL were associated with ramp lesions, MFC bone oedema close to the dMCL attachment, and sMCL injury. Missed AMRI is a risk factor for ACL graft failure from overload and, hence, oedema in the MCL (especially dMCL) demands careful assessment for AMRI, even in the knee lacking excess valgus laxity. This study provides information about specific MCL injury patterns including the dMCL in ACL ruptures and will allow surgeons to initiate individualised treatment. LEVEL OF EVIDENCE: III.

Indexed as

Anterior Cruciate Ligament InjuriesCollateral LigamentsJoint InstabilityMedial Collateral Ligament, KneeAdolescentAdultAnterior Cruciate LigamentHumansIncidenceKnee JointRange of Motion, ArticularRetrospective StudiesTibiaYoung AdultAnterior cruciate ligamentAnteromedial rotatory instabilityDeep MCL injuryMagnetic resonance imagingMedial collateral ligament

Identifiers

PMID33661325
PMCPMC8800884
OpenAlexW3133676243

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LicenceCC BY
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.