Does Release of the Superficial Medial Collateral Ligament Result in Clinically Harmful Effects After the Fixation of Medial Meniscus Posterior Root Tears?

Abstract

Purpose: To investigate pain and tenderness, stress testing, clinical outcome scores, complications, and operation time at 24 months and magnetic resonance imaging (MRI) analysis at 12 months after the release of the distal attachment of the superficial medial collateral ligament (sMCL) during medial meniscus posterior root tear (MMPRT) fixation. Methods: Patients who received MMPRT fixation with a follow-up of at least 2 years were included. During fixation, the release of the distal attachment of the sMCL on the proximal tibia was performed to improve visualization and provide sufficient working space. Pain and tenderness at the released area, manual valgus stress tests of 30 degrees and 0 degrees flexion (grade 0/1/2/3), and subjective instability during weight bearing were evaluated serially at postoperative 3, 6, 12, and 24+ months. The contour of detachment area was assessed using MRI 12 months postoperatively. As a subgroup analysis, tourniquet time (minutes) and final clinical scores were compared between release and nonrelease groups. Results: The numbers of participants in the release and nonrelease groups were 118 and 20 patients, and their mean follow-up durations were 42.4 +/- 19.3 (24-95) and 37.2 +/- 7.8 (30-55) months, respectively. In the release group, percentages of patients with pain and tenderness at 3 months were 15% and 18%, respectively; however, no patients had symptoms at 12 months. In valgus stress tests (30 degrees, 0 degrees), 12% and 2% of patients showed grade 1 laxity at 3 months, and 7% had grade 1 laxity in only 30 degrees flexion at the final follow-up. However, no patients had subjective valgus laxity. An intact contour was confirmed in all cases among 94 patients checked by performing follow-up MRI. Tourniquet time was significantly shorter in the release group (42.4 +/- 19.3) than in the nonrelease group (58.5 +/- 9.5; P<.001). Between release and nonrelease groups, Lysholm (84.4 +/- 12.1, 88.1 +/- 12.8; P=.117) and International Knee Documentation Committee scores (73.6 +/- 11.2, 77.5 +/- 11.9; P=.112) did not differ. Conclusions: The release of the distal attachment of the sMCL during fixation of MMPRT did not result in pain and tenderness, residual instability, and complication. An intact contour of the sMCL was confirmed in all cases with MRI. This procedure reduced operation time and showed similar clinical results when compared between the release and nonrelease groups. However, this study had low power to detect the difference for clinical scores between the 2 groups. Level of Evidence: Level IV, therapeutic case series.