I'd like to thank all my co-authors. Here are my disclosures, none relevant to this talk. So the background for conducting the study was pretty straightforward. We originally developed an MCL augmented repair technique that we thought was much more efficient. And we demonstrated biomechanical equivalence in the lab to complete MCL reconstruction. So we wanted to translate our findings from the lab into the clinic and see if we can demonstrate equivalence in terms of knee stability and patient-reported outcomes. So we conducted a randomized control trial among three centers. In the United States, it was the Stedman Clinic in Vail, Colorado, University of Oslo in Norway, and Aarhus University in Denmark. And we compared both clinical outcomes and objective knee laxity between the two procedures. We included only grade three MCL tear patients with or without concomitant ACL injuries. All surgeries were performed by three surgeons over the course of six years, and our primary outcome variable was valgus stress radiographs, and we used the side-to-side difference of 3.2 millimeters as the cutoff for both diagnosis as well as failure, and that's popularized by Dr. LaPrade. And we were concerned with two main follow-up points, six and 12 months, and that was really to look at early and complete or delayed healing. So for the augmented repair, it's more of a modified reconstruction. So figure A is our augmented repair. What we do is we harvest the gracilis and semitendinosus and detach it proximally, leave them intact distantly, fix it in the tibia with two suture anchors, reroute them underneath the sartorial fascia over top the native MCL, and then fix it in the femur with a closed, we drill a closed tunnel and fix it with an interference screw. And then at figure B, it's just a complete standard MCL reconstruction. You're harvesting both semitendinosus and gracilis, whip stitching both ends, drilling two tunnels and fixing with two screws. So I think a key point for our study was the rehabilitation was the exact same for all patients. They were non-weight-bearing on crutches for six weeks, but they were all enrolled in an early knee range of motion program. They were allowed range of motion zero to 90 degrees for the first two weeks, and then they were allowed to progress thereafter. And again, statistically we were mainly concerned with equivalence instead of superiority. So ultimately we enrolled 54 patients, average age was 38, average BMI was 25. And you can see that there were no, all patients improved from pre-op to post-operative significantly based on valgus stress radiographs, but there were no significant differences between the two time points post-operatively. And this equivalence plot just reiterates that. It shows that again, no significant differences based on valgus stress x-rays at both six and 12 month time points. And when looking at patient reported outcomes or subjective outcomes, Leistholm and IKD scores were significantly higher in our MCL reconstruction group, but there were no significant differences between Tegner and patient satisfaction scores. So thankfully there were no major complications such as DVT infection or arthrofibrosis, and there were no reported MCL graph failures as determined based on our valgus stress x-rays and physical examination at a minimum of 12 month follow-up. So we were able to demonstrate similar findings to our biomechanical study. And this study provides clinical evidence to support either an MCL reconstruction or MCL repair with the use of a hamstring tendon autograph. However, future studies are needed to determine superiority in terms of multitude of factors, cost effectiveness, operative time, as well as functional performance outcomes. Limitations, there was heterogeneity in preoperative variables between randomized groups. We included both ACL and MCL tear patients which could have affected our clinical outcomes. And there were differences in patient enrollment numbers between study centers. So in conclusion, we were able to demonstrate clinical equivalence for an MCL augmented repair compared to an MCL reconstruction technique. Subjective outcomes did favor MCL reconstruction over repair. But overall, this randomized control trial demonstrated that an anatomic-based treatment of MCL tears with an early knee range of motion program can have low risk of graft attenuation and low rate of complications. Thank you very much.

randomized control trial

MCL augmented repair technique

complete MCL reconstruction

grade three MCL tear

concomitant ACL injuries