New Study Sheds Light on Rare Stener-Like Knee Injuries

One of the more rare sports related knee injuries, a Stener-like injury of the medial collateral ligament with a displacement which impedes healing, is the subject of a new study from Princess Grace Hospital in London.

The study, “Surgical Repair of Stener-like Injuries of the Medial Collateral Ligament of the Knee in Professional Athletes,” was published online on May 20, 2020 in The American Journal of Sports Medicine.

“A ‘Stener-like’ lesion of the knee is defined as a distal avulsion of the superficial medial collateral ligament with interposition of the pes anserinus between the ligament and its tibial insertion—a displacement impeding anatomic healing. Because of the scarcity of these injuries, the literature is limited to case reports and small case series,” the researchers wrote.

In their study, the Princess Grace Hospital team assessed return to preinjury level of sporting function, time to return to preinjury level of sporting function, functional performance, injury recurrence and other complications. Following surgical repair of acute Stener-like lesions of the superficial medial collateral ligament.

All 23 of the elite athletes enrolled in the study had their surgeries performed by the same surgeon. The mean age of the patients was 27.2 years (range, 19-37 years). The majority were men. The mean body mass index was 23.1 ± 2.3. Sixteen of the athletes were soccer players and seven were rugby players.

The surgical repair involved primary suture anchor repair with ligament repair or reconstruction system augmentation. Minimum follow-up was 24 months (range, 24-108 months) from the date of surgery.

The mean time from injury to surgery was nine days (range, 3-28 days). Fifteen of the athletes had isolated distal superficial medial collateral ligament injuries requiring anatomic suture anchor repair at the distal tibial insertion site only, and eight of the athletes had concomitant injuries of the proximal and distal superior medial collateral ligament and required anatomic suture anchor repair at the proximal and distal attachment sites.

In addition, ten of the athletes underwent Ligament Advanced Reinforcement System or LARS augmentation at the time of the surgery. All of the athletes returned to their preinjury level of sporting activity in professional soccer or rugby. The mean time from surgical intervention to return to full sporting activity was 16.8 ± 2.7 weeks.

At 6 and 24 months’ follow-up, all patients had Tegner scores of 10. And at a 2-year follow-up, they were all still participating at their preinjury level of sporting activity. Three of the athletes developed complications around the LARS that required further surgery to remove synthetic material. However, this did not affect function.

“Surgical repair of acute Stener-like lesions of superficial medial collateral ligament is associated with a high return to preinjury level of sporting function, excellent functional performance, and a low risk of recurrence at short-term follow-up in elite athletes,” the researchers wrote.

The study authors include Joshua W. Thompson, MBChB, BSc, Vishal Rajput, MBBS, DNB (Ortho), Babar Kayani, MBBS, Bsc (Hons), Ph.D., Ricci Plastow, MBBS, Ahmed Magan, MBBS, Fares S. Haddad, BSc, M.D. (Res), all of the Princess Grace Hospital in London, UK.