{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T02:10:05Z","timestamp":1791252605529,"version":"4.1.0"},"reference-count":40,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2021,3,4]],"date-time":"2021-03-04T00:00:00Z","timestamp":1614816000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2021,3,4]],"date-time":"2021-03-04T00:00:00Z","timestamp":1614816000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,3,4]],"date-time":"2021-03-04T00:00:00Z","timestamp":1614816000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100005713","name":"Technische Universit\u00e4t M\u00fcnchen","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100005713","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100005713","name":"Technische Universit\u00e4t M\u00fcnchen","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100005713","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"published-print":{"date-parts":[[2022,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>In anterior cruciate ligament (ACL) injuries, concomitant damage to peripheral soft tissues is associated with increased rotatory instability of the knee. The purpose of this study was to investigate the incidence and patterns of medial collateral ligament complex injuries in patients with clinically \u2018isolated\u2019 ACL ruptures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Patients who underwent ACL reconstruction for complete \u2018presumed isolated\u2019 ACL rupture between 2015 and 2019 were retrospectively included in this study. Patient\u2019s characteristics and intraoperative findings were retrieved from clinical and surgical documentation. Preoperative MRIs were evaluated and the grade and location of injuries to the superficial MCL (sMCL), dMCL and the posterior oblique ligament (POL) recorded. All patients were clinically assessed under anaesthesia with standard ligament laxity tests.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Hundred patients with a mean age of 22.3\u2009\u00b1\u20094.9 years were included. The incidence of concomitant MCL complex injuries was 67%. sMCL injuries occurred in 62%, dMCL in 31% and POL in 11% with various injury patterns. A dMCL injury was significantly associated with MRI grade II sMCL injuries, medial meniscus \u2018ramp\u2019 lesions seen at surgery and bone oedema at the medial femoral condyle (MFC) adjacent to the dMCL attachment site (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01). Logistic regression analysis identified younger age (OR 1.2,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05), simultaneous sMCL injury (OR 6.75,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01) and the presence of bone oedema at the MFC adjacent to the dMCL attachment site (OR 5.54,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01) as predictive factors for a dMCL injury.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The incidence of combined ACL and medial ligament complex injuries is high. Lesions of the dMCL were associated with ramp lesions, MFC bone oedema close to the dMCL attachment, and sMCL injury. Missed AMRI is a risk factor for ACL graft failure from overload and, hence, oedema in the MCL (especially dMCL) demands careful assessment for AMRI, even in the knee lacking excess valgus laxity. This study provides information about specific MCL injury patterns including the dMCL in ACL ruptures and will allow surgeons to initiate individualised treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of evidence<\/jats:title>\n                    <jats:p>III.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00167-021-06514-x","type":"journal-article","created":{"date-parts":[[2021,3,4]],"date-time":"2021-03-04T08:07:12Z","timestamp":1614845232000},"page":"167-175","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":107,"title":["High incidence of superficial and deep medial collateral ligament injuries in \u2018isolated\u2019 anterior cruciate ligament ruptures: a long overlooked injury"],"prefix":"10.1002","volume":"30","author":[{"given":"Lukas","family":"Willinger","sequence":"first","affiliation":[{"name":"<!--<label>2<\/label>--> Department of Trauma and Orthopaedics Chelsea and Westminster Hospital, Chelsea and Westminster NHS Foundation Trust London UK"},{"name":"<!--<label>3<\/label>--> Department of Orthopaedic Sports Medicine Technical University of Munich Ismaninger Stra\u00dfe 22 81675 Munich Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ganesh","family":"Balendra","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Fortius Clinic 17 Fitzhardinge St W1H 6EQ London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vishal","family":"Pai","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Fortius Clinic 17 Fitzhardinge St W1H 6EQ London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin","family":"Lee","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Fortius Clinic 17 Fitzhardinge St W1H 6EQ London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam","family":"Mitchell","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Fortius Clinic 17 Fitzhardinge St W1H 6EQ London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary","family":"Jones","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Fortius Clinic 17 Fitzhardinge St W1H 6EQ London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andy","family":"Williams","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Fortius Clinic 17 Fitzhardinge St W1H 6EQ London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,3,4]]},"reference":[{"key":"e_1_2_9_2_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167\u2010020\u201006133\u2010y"},{"key":"e_1_2_9_3_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167\u2010020\u201006139\u20106"},{"key":"e_1_2_9_4_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167\u2010020\u201006084\u20104"},{"key":"e_1_2_9_5_2","doi-asserted-by":"publisher","DOI":"10.1148\/radiology.219.2.r01ma23381"},{"key":"e_1_2_9_6_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167\u2010014\u20103095\u20101"},{"key":"e_1_2_9_7_2","first-page":"45","article-title":"High prevalence of anterolateral ligament abnormalities in magnetic resonance images of anterior cruciate ligament\u2010injured knees","volume":"80","author":"Claes S","year":"2014","journal-title":"ActaOrthopBelg"},{"key":"e_1_2_9_8_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301\u2010620X.96B3.33033"},{"key":"e_1_2_9_9_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00256\u2010016\u20102479\u20103"},{"key":"e_1_2_9_10_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167\u2010018\u20104949\u20108"},{"key":"e_1_2_9_11_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF01560215"},{"key":"e_1_2_9_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2016.05.009"},{"key":"e_1_2_9_13_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167\u2010017\u20104498\u20106"},{"key":"e_1_2_9_14_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167\u2010018\u20105209\u20107"},{"key":"e_1_2_9_15_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11999-009-0711-3"},{"key":"e_1_2_9_16_2","doi-asserted-by":"publisher","DOI":"10.2106\/00004623\u2010197153070\u201000001"},{"key":"e_1_2_9_17_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00256\u2010018\u20103128\u20109"},{"key":"e_1_2_9_18_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546520918207"},{"key":"e_1_2_9_19_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546515614312"},{"key":"e_1_2_9_20_2","unstructured":"KittlC RobinsonJ RaschkeMJ OlbrichA FrankAet al. 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