Augmentation does not improve clinical and radiological outcomes after repair of Stener‐like medial collateral ligament (MCL) lesions: Comparative cohort at mid‐term follow‐up
Rodrigo Olivieri, José Tomás Muñoz, Marco Koch, Rodrigo Rojas, Nicolás Franulic, Tomás Pineda, Piero Innocenti, Alberto GrassiAbstract
Purpose
To compare radiographic valgus stability, patient‐reported outcome measures (PROMs), and complication and failure rates between patients treated with isolated repair of Stener‐like medial collateral ligament (MCL) lesions and those who received repair with augmentation. We hypothesised that repair with augmentation would result in superior radiographic stability and improved clinical outcomes.
Methods
A retrospective cohort study was performed on consecutive patients aged ≥18 years who underwent surgical treatment for distal MCL avulsion injuries with pes anserinus interposition between January 2015 and December 2022 at a single institution, with a minimum follow‐up of 24 months. Surgical treatment consisted of isolated repair or repair with biological augmentation using autograft or allograft tissue. Functional outcomes were assessed using Lysholm and Knee Osteoarthritis Outcome Score (KOOS) scores. Radiographic valgus stability was evaluated using stress radiographs obtained at 3 months post‐operatively.
Results
Twenty‐nine patients were included, of whom 19 (65.5%) underwent isolated repair and 10 (34.5%) underwent repair with augmentation. Eighteen patients (62.1%) had multiligament injuries, and the mean time from injury to surgery was 33.1 ± 17.8 days. Both groups showed a significant reduction in medial joint gapping on valgus stress radiographs, with no differences between techniques ( p = 0.985). The mean Lysholm score for the entire cohort was 89.3 ± 15.4, with no significant differences between groups ( p = 0.940). Similarly, no differences were observed in any KOOS subscale. Seven complications (24.1%) were recorded, most commonly post‐operative stiffness requiring arthroscopic lysis of adhesions. Complication rates were comparable between groups ( p = 0.664). One failure occurred in the isolated repair group, requiring MCL reconstruction.
Conclusions
Surgical treatment of Stener‐like MCL lesions provides good radiographic and functional outcomes at mid‐term follow‐up. Repair with augmentation does not result in superior outcomes compared with isolated repair, suggesting that anatomic repair alone may be sufficient in most cases.
Level of Evidence
Level III, retrospective cohort study.