ABSTRACT
A prospective study was designed to compare the results of operative and non-Dwaine treatment of complete Grade-1111 isolated tears of the medial collateral ligament of the knee. For eighteen consecutive months, all patients suspected of haling this injury were examined under anesthesia and arthroscopically before primary surgical repair was per-formed. At the time of surgery. the preoperative diagnosis was confirmed in all knees. Surgery was followed by a six-week period of immobilization of the knee in a plaster cast and a well defined, supervised rehabilitation program. These patients comprised Group I. For the ensuing eighteen months, all patients with this in-jury of the medial collateral ligament were also examined under anesthesia and by Arthroscopy but were treated by immobilization of the knee in a plaster cast for two weeks, the use of a cast-brace for four weeks, and the same rehabilitation program as was used in Croup I. These patients comprised Croup II. Sixteen patients in Group I were followed for an average of 3.1 years and twenty patients in Group II, for an average of 2.4 years. In both groups, examination under anesthesia and arthroscopic evaluation of the intraarticular structures demonstrated that there was no structural damage to the anterior cruciate ligament, menisci, or articular surfaces. Fifteen of the sixteen patients in Group I and seventeen of the twenty patients in Group II had a good or excellent result. The results seem to indicate that primary surgical repair of a complete (Grade III) isolated tear of the medial collateral ligament is not necessarily indicated. Rehabilitation was expedited in the patients who were treated with cast-bracing alone, since these patients regained their strength, as measured by the Cybex-II machine, in significantly (p < 0.001) less time (Group I, 14.9 ± 1.5 weeks and Group II, 11.3 ± 1.8 weeks). The key to success in the treatment of this injury is to establish that there is an isolated lesion with no associated damage to other vital structures, particularly to the anterior cruciate ligament and the menisci.