Non-operative treatment of the MCL in combined ACL MCL injuries .
This report has been verified
by one or more authors of the
original publication.
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2013;1(5):89 J Bone Joint Surg Am. 2009 Jun;91(6):1305-12.47 patients with combined anterior cruciate ligament (ACL) and medial collateral ligament (MCL) injuries were randomized to receive either operative treatment on both ACL and MCL or operative treatment just on ACL. It was observed that the non-operative treatment of the MCL led to a greater range of motion and recovery of quadriceps power generation during early follow-ups.
Was the allocation sequence adequately generated?
Was allocation adequately concealed?
Blinding Treatment Providers: Was knowledge of the allocated interventions adequately prevented?
Blinding Outcome Assessors: Was knowledge of the allocated interventions adequately prevented?
Blinding Patients: Was knowledge of the allocated interventions adequately prevented?
Was loss to follow-up (missing outcome data) infrequent?
Are reports of the study free of suggestion of selective outcome reporting?
Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)?
Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events?
Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)?
Sí = 1
Incierto = 0,5
No relevante = 0
No = 0
La evaluación de los criterios de información evalúa la transparencia con la que los autores informan de las características metodológicas y del ensayo dentro de la publicación. La evaluación se divide en cinco categorías que se presentan a continuación.
3/4
Randomization
3/4
Outcome Measurements
2/4
Inclusion / Exclusion
4/4
Therapy Description
4/4
Statistics
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
El Índice de Fragilidad es una herramienta que ayuda en la interpretación de hallazgos significativos, proporcionando una medida de fuerza para un resultado. El Índice de Fragilidad representa el número de eventos consecutivos que es necesario añadir a un resultado dicotómico para que el hallazgo deje de ser significativo. Un número pequeño representa un hallazgo más débil y un número grande un hallazgo más fuerte.
¿Por qué se necesitaba ahora este estudio?
Isolated MCL injuries are commonly treated with non-operative care. However, there is no consensus for the standard of care in patients who have injured both ACL and MCL ligaments in the same knee. Surgical repair of both ligaments, while providing knee stability, has recently found to be associated with decreased post-operative range of motion and quadriceps muscle power. This trial examined differences in range of motion and quadriceps power between operative and non-operative treatment of the MCL in combined ACL and MCL injuries.
¿Cuál era la pregunta principal de la investigación?
In patients with combined ACL and MCL injuries (tears), does non-operative treatment of the MCL provide better postoperative range of motion, without sacrificing stability when compared to operative repair?
- Flexion deficit was greater in the MCLS group (both ACL and MCL repair) at all follow-up time points, but was only significant at 6 weeks (100 vs 112 degrees; p=0.009), 12 weeks (119 vs 128 degrees; p=0.043), and 32 weeks (130 vs 136 degrees; p=0.011)
- At 1 and 2 year follow-up, knee flexion was similar between the two groups (MCLS =132 and MCLNO= 134 degrees; MCLS=134 and MCLNO=137 degrees)
- At 1 year, quadriceps muscle power was 30.7% in the MCLS group and 20.5% in the MCLNO group (p=0.015). At 104 weeks, this difference was no longer significant, but favoured the MCLNO group (14.4% vs 9.7%; p=0.2)
- 96% (45/47) patients exhibited normal flexion, according to the International Knee Documentation Committee criteria
¿Qué es lo que más debo recordar?
Results from this study favoured the non-operative treatment for the MCL in patients with combined ACL and MCL injuries. At one year, quadriceps muscle power was greater in the non-operative group. However, at two years, muscle power, and ROM were equal in both groups.
¿Cómo afectará esto al cuidado de mis pacientes?
This study indicates that non-operative treatment of the MCL in combined ACL and MCL injuries provides improved quadriceps muscle power recovery and ROM when examined during short term follow-up, with no differences apparent at long term follow-up.
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