Early Surgical Intervention Results in Better Patient-Reported Outcomes Than Delayed Treatment in Patients Undergoing Anterior Cruciate Ligament Reconstruction in the Presence of Concomitant Medial Collateral Ligament Injury

Abstract

Purpose

To investigate the influence of the timing of anterior cruciate ligament (ACL) reconstruction (ACLR) on patient-reported outcomes, comparing patients with and without concomitant medial collateral ligament (MCL) injury.

Methods

This study included patients who underwent ACLR between September 2015 and October 2020. The inclusion criteria included patients for whom preoperative and postoperative patient-reported outcome measures were available and a follow-up period of at least 2 years. Patients who sustained grade 2 or 3 MCL injuries with ACL tears were compared with patients with no MCL injuries as a control. All patients underwent ACLR with either bone-tendon-bone autograft or bone-tendon-bone allograft. Patient-reported outcomes (International Knee Documentation Committee [IKDC] score, Lysholm score, and Knee Injury and Osteoarthritis Outcome Score [KOOS]) were recorded, and outcomes were analyzed by sex and time from index injury. A stratified linear mixed-effects regression analysis was conducted.

Results

A total of 253 eligible patients with 2-year outcomes were enrolled. Patients with combined ACL-MCL injuries had lower IKDC scores (β = –6.1 vs β = –8.3, P = .003), KOOS Quality of Life values (β = –9.3 vs β = –11, P = .004), and KOOS Sport values (β = –12 vs β = –13, P = .08) if surgery was performed more than 6 weeks after the index injury. Patients with isolated ACL injuries showed lower KOOS Activities of Daily Living values (β = –2.4, P = .045) if surgery was performed at between 3 and 6 months. Among patients with combined ACL-MCL injuries, autograft was found to have worse IKDC scores (β = –11 [95% confidence interval (CI), –18 to –4.2]; P = .002), Lysholm scores (β = –9.2 [95% CI, –15 to –3.1]; P = .004), KOOS Quality of Life values (β = –11 [95% CI, –20 to –1.6]; P = .023), KOOS Pain values (β = –5.1 [95% CI, –10 to –0.03]; P = .049), KOOS Symptoms values (β = –7.6 [95% CI, –10 to –0.03]; P = .02), and KOOS Sport values (β = –21 [95% CI, –32 to –10]; P < .001) than allograft.

Conclusions

Patients undergoing ACLR with grade 2 or 3 MCL injuries have improved patient-reported outcomes if surgery is performed within 6 weeks from the time of injury. In this cohort, allografts resulted in better outcome scores compared with autografts.

Level of Evidence

Level III, retrospective cohort study.