Treatment of combined anterior cruciate ligament-Medial collateral Ligament (ACL-MCL) injuries with ACL reconstruction and nonoperative MCL management

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  • ABSTRACTS 349

    lar cartilage, but in fact the possibility of significant subsequent cartilage necrosis. These results are of considerable significance and have important impli- cations for the use of this technology in routine ar- throscopic surgery.

    The Results of Hip Arthroscopy by the Lateral Ap- proach. James M. Glick and Thomas G. Sampson. Private practice, San Francisco, California, U.S.A.

    We sought to show the benefits of hip arthros- copy and to describe a technique that expedites ac- cess to the hip joint.

    Methods: The patient is placed on his or her side with the involved hip upward. Traction is applied on the leg to distract the hip. Portals are made over the greater trochanter and directly anterior.

    A total of 124 hip arthroscopies have been fol- lowed for 2 years or more. Of these, 62 (50%) were arthritic. The others were treated for labral tears, loose bodies, foreign bodies, and synovial disease.

    Results: Arthroscopy was helpful in 68% of the 124 cases. Fifty-nine percent of the arthritics that were debrided (62 hips) had significant improve- ment. There was 85-90% improvement in those in- dividuals who were treated for labral tears, loose bodies, foreign bodies, and synovial disease. Ar- throscopic evaluation led to other nonarthroscopic procedures, such as osteotomies and total hip re- placements, in five cases. There were no complica- tions.

    Conclusion: Arthroscopy by the lateral approach allows for a complete undistorted view of the anat- omy of the hip joint. Pathology is better appreci- ated, and the treatment options are increased.

    Arthroscopy was valuable for diagnosing labral tears and synovial diseases. Debridement of joints arthritic as a result of trauma that do not have ebur- nation or dysplasia can be expected to provide fa- vorable results lasting for many months or years. Recently arthroscopy was used to explore and treat conditions of the trochanteric bursa and iliopsoas tendon.

    Treatment of Combined Anterior Cruciate Ligament- Medial Collateral Ligament (ACL-MCL) Injuries with ACL Reconstruction and Nonoperative MCL Management. David G. Doctor, Wesley M. Nottage, Peter Matsuura, Marc Friedman, James Fox, Wilson Del Pizzo, and Richard D. Ferkel. The Sports Clinic, Laguna Hills, and Southern Califor-

    nia Orthopedic Institute, Van Nuys, California, U.S.A.

    A retrospective review of the clinical records of 55 patients with combined anterior cruciate liga- ment-mediai collateral ligament (ACL-MCL) inju- ries was undertaken at two institutions covering a 6-year period from 1986 to 1992. Arthroscopically assisted reconstruction of the ACL using pateUar tendon graft was performed for 35 patients, whereas 20 patients underwent ACL reconstruction using semitendinosus-gracilis tendon. All concomitant MCL injuries were managed nonoperatively.

    Patients were followed for 1 to 6 years. Func- tional stability and range of motion were evaluated objectively by means of physical examination and KT-1000 testing. Subjective data was used to assess postoperative level of activity. The study group of patients was compared with a reference group that had isolated ACL injuries and was similarly recon- structed with either patellar tendon graft or semi- tendinosus-gracilis tendon. Results showed no sig- nificant difference in knee stability, range of mo- tion, or postoperative level of function between the study and reference groups. In addition, an equally favorable functional outcome was noted for patients who underwent ACL reconstruction with patellar tendon and for those who were reconstructed with semitendinosus-gracilis tendon.

    We conclude that combined ACL-MCL injuries can be treated as isolated ACL injuries by recon- struction of the ACL and nonoperative manage- ment of the MCL with no compromise in functional outcome. In addition, our results suggest that re- construction of the ACL using semitendinosus- gracilis tendon may provide long-term results as ac- ceptable as those with pateUar tendon grafts.

    Arthroscopic Bankart Suture Repair for Recurrent Anterior Shoulder Instability: Fifty-one Cases with Minimum 2-Year Follow-up. John W. Uribe, Keith S. Hechtman, John E. Zvijac, and William H. Thompson. University of Miami Sports Medicine, and private practice, Coral Gables, Florida, U.S.A.

    Ninety consecutive patients underwent arthro- scopic Bankart suture repair for isolated, recurrent, anterior glenohumeral instability. Forty-nine pa- tients with minimum 2-year follow-up were evalu- ated. Fifty-one procedures in 41 males and eight females were performed by the senior authors. All patients undergoing stabilization for shoulder insta- bility underwent an arthroscopic evaluation. Those

    Arthroscopy, Vol. 10, No. 3, 1994

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