Healing of Acute Collateral Ligament Tears Associated with Cruciate Ligament Injuries Treated Conservatively by Early Protective Motion

Hidetoshi Ihara; Yoshihiro Noro; Megumi Miwa; Kiyomi Takayanagi; Keizo Deya; Hiroto Nakagawa

doi:10.5035/nishiseisai.42.673

Hidetoshi Ihara, Yoshihiro Noro, Megumi Miwa, Kiyomi Takayanagi, Keizo Deya, Hiroto Nakagawa

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JOURNAL FREE ACCESS

1993 Volume 42 Issue 2 Pages 673-676

DOI https://doi.org/10.5035/nishiseisai.42.673

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Published: March 25, 1993 Received: - Available on J-STAGE: February 25, 2010 Accepted: - Advance online publication: - Revised: -
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Date of correction: February 25, 2010 Reason for correction: - Correction: CITATION Details: Wrong : 1) Ballmer, P. M. and Jakob, R. P.: The non-operative treatment of isolated complete tears of the medial collateral ligament of the knee. A prospective study. Arch. Orthop. Trauma. Surg. 107: 273-276, 1988.
2) Hart, D. P. et al.: Healing of the medial collateral ligament injury in rats. J. Bone Joint Surg. 69-A: 1194-1199, 1987.
8) Indelicato, P. A. et al.: Nonoperative management of complete tears of the medial collateral ligament of the knee in intercollegiate football players. Clin. Orthop. 256: 174-177, 1990.
9) Inoue, M. I. et al.: Treatment of the medial collateral ligament injury. The importance of anterior cruciate ligament on the varus-valgus knee laxity. Am. J. Sports Med. 15: 1 5-21, 1987.
10) Jork, P. et al.: Non-operative treatment of severe injuries to the medial and anterior cruciate ligaments of the knee. J. Bone Joint Surg. 66-A: 741-744, 1984.
11) Lundberg, M. and Hamberg, P.: Early mobilization of isolated partial ruptures of the medial collateral ligament. A randomized comparison of bracing and elastic wrapping. Surg. Arthroscopy Knee 2nd Congress Europ Soc, Ed. Müller, Springer-Verlag, 1988, pp 112-115.
14) Mork, D. W. H. and Cood, C.: Non-operative management of acute grade III medial collateral ligament injury of the knee. A prospective study. Injury. 20: 277-280, 1989.
15) Ogata, K. et al.: The intra-articular effect of various postoperative management following knee ligament repair. Clin. Orthop. 150: 271-276, 1980.
16) Piper, T. L. and Whiteside, L. A.: Early mobilization after knee ligament re pair in dogs. Clin. Orthop. 150: 277-282, 1980.
17) Sandberg, R. et al.: Operative versus non-operative treatment of recent injuries to the ligaments of the knee. A prospective randomized study. J. Bone Joint Surg. 69-A: 1120-1126, 1987.
18) Seiler, H. et al.: Isolated tears of the medial collateral ligament of the knee. Operative or conservative treatment? Surg. Arthroscopy Knee 2nd Congress Europ. Soc, Ed. Muller, Springer-Verlag, 1988.
19) Woo, S. L. Y. et al.: Treatment of the medial collateral ligament injury. Stricture and function of canine knees in response to differing treatment regiments. Am. J. Sports Med. 15: 22-29, 1987.

Right : 1) Ballmer, P. M. and Jakob, R. P.: The non-operative treatment of isolated complete tears of the medial collateral ligament of the knee. A prospective study. Arch. Orthop. Trauma. Surg. 107: 273-276, 1988.
2) Hart, D. P. et al.: Healing of the medial collateral ligament injury in rats. J. Bone Joint Surg. 69-A: 1194-1199, 1987.
8) Indelicato, P. A. et al.: Nonoperative management of complete tears of the medial collateral ligament of the knee in intercollegiate football players. Clin. Orthop. 256: 174-177, 1990.
9) Inoue, M. I. et al.: Treatment of the medial collateral ligament injury. The importance of anterior cruciate ligament on the varus-valgus knee laxity. Am. J. Sports Med. 15: 1 5-21, 1987.
10) Jork, P. et al.: Non-operative treatment of severe injuries to the medial and anterior cruciate ligaments of the knee. J. Bone Joint Surg. 66-A: 741-744, 1984.
11) Lundberg, M. and Hamberg, P.: Early mobilization of isolated partial ruptures of the medial collateral ligament. A randomized comparison of bracing and elastic wrapping. Surg. Arthroscopy Knee 2nd Congress Europ Soc, Ed. Müller, Springer-Verlag, 1988, pp 112-115.
14) Mork, D. W. H. and Cood, C.: Non-operative management of acute grade III medial collateral ligament injury of the knee. A prospective study. Injury. 20: 277-280, 1989.
15) Ogata, K. et al.: The intra-articular effect of various postoperative management following knee ligament repair. Clin. Orthop. 150: 271-276, 1980.
16) Piper, T. L. and Whiteside, L. A.: Early mobilization after knee ligament repair in dogs. Clin. Orthop. 150: 277-282, 1980.
17) Sandberg, R. et al.: Operative versus non-operative treatment of recent injuries to the ligaments of the knee. A prospective randomized study. J. Bone Joint Surg. 69-A: 1120-1126, 1987.
18) Seiler, H. et al.: Isolated tears of the medial collateral ligament of the knee. Operative or conservative treatment? Surg. Arthroscopy Knee 2nd Congress Europ. Soc, Ed. Muller, Springer-Verlag, 1988.
19) Woo, S. L. Y. et al.: Treatment of the medial collateral ligament injury. Stricture and function of canine knees in response to differing treatment regiments. Am. J. Sports Med. 15: 22-29, 1987.

Date of correction: February 25, 2010 Reason for correction: - Correction: PDF FILE Details: -

Abstract

The purpose of this study was to evaluate natural healing of the collateral ligament associated with cruciate ligament injury when treated conservatively by early protective motion. Acute ligamentous injuries of the MCL in 10 patients and of the LCL in another 3 patients, who had concomitant ACL injury in 11 patients and PCL in 2 patients, were the subjects of this study. A Kyuro knee brace with a coil-spring traction system was used to add adequate but not excessive stress to the injured tissues at an early stage. Dynamic joint control training was conducted progressively to improve the muscles ability to protect the joint. All patients were examined before treatment and then re-examined after the 3-month treatment, both radiologically and arthroscopically. Ten patients were also evaluated by MR imaging. Lateral laxity on stress radiographs under anaesthesia decreased from an average of 13.5 to 5.5mm (p<0.01) after treatment. Most of the arthroscopic findings of ruptured ligaments returned to a normal appearance. Results that were rated as “good to excellent” were obtained in 90% of those examined by MRI. Associated ACL healed well, but PCL poorly. We concluded that acute collateral ligament tears can be healed morphologically and mechanically by this non-surgical method, even when complicated with cruciate ligament injuries.

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