A Triple-Strand Anatomic Medial Collateral Ligament Reconstruction Restores Knee Stability More Completely Than a Double-Strand Reconstruction: A Biomechanical Study In Vitro

Miyaji, Noriaki; Holthof, Sander; Bastos, Ricardo P.S.; Ball, Simon; Espregueira-Mendes, João; Williams, Andy; Amis, Andrew A.

doi:10.1177/03635465221090612

Cited by 19 publications

(45 citation statements)

References 45 publications

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“…The changes in stability after transecting the medial ligaments are supported by other studies. Anteroposterior translation did not change significantly after MCL transection, as reported previously, 25 , 36 because the ACL and posterior cruciate ligament, the primary restraints, 6 , 11 , 28 remained intact. ER in the native knee increased with flexion and was increased significantly at all angles of flexion after a dMCL plus sMCL injury.…”

Section: Discussionsupporting

confidence: 83%

“…A dMCL graft has also been reported as part of anatomic 3-strand reconstruction, which was found to restore native ER. 25 A limitation of the present study is that it concerns only reconstruction of the passive medial ligamentous restraints. Further work could add simulated injuries of the peripheral meniscocapsular and semimembranosus tendon attachments to the posteromedial structures.…”

Section: Discussionmentioning

confidence: 99%

“…A dMCL graft has also been reported as part of anatomic 3-strand reconstruction, which was found to restore native ER. 25 …”

Section: Discussionmentioning

confidence: 99%

“…It has been shown that 3-strand (sMCL 1 dMCL 1 POL) reconstruction can restore native knee stability. 25 The aim of the present work was to design and test a reconstruction method, based on the evidence cited in the preceding paragraphs, that would include dMCL and sMCL grafts. It was hypothesized that this novel anatomic AM reconstruction technique would restore AM laxity (anterior tibial translation [ATT], ER, valgus, and AMRI [ATT plus ER combined]) to match native knee laxity.…”

mentioning

confidence: 99%

“…It has been shown that 3-strand (sMCL + dMCL + POL) reconstruction can restore native knee stability. 25 …”

mentioning

confidence: 99%

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Medial Collateral Ligament Reconstruction for Anteromedial Instability of the Knee: A Biomechanical Study In Vitro

et al. 2022

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Background: Although a medial collateral ligament (MCL) injury is associated with anteromedial rotatory instability (AMRI) and often with an anterior cruciate ligament (ACL) injury, there has been little work to develop anteromedial (AM) reconstruction to address this laxity. Purpose: To measure the ability of a novel “anatomic” AM reconstruction technique to restore native knee laxity for isolated AM insufficiency and combined AM plus posteromedial insufficiency. Study Design: Controlled laboratory study. Methods: A total of 12 cadaveric knees were mounted in a kinematic testing rig that allowed the tibia to be loaded while the knee flexed-extended 0° to 100° with 88-N anteroposterior translation, 5-N·m internal rotation–external rotation (ER), 8-N·m valgus, and combined anterior translation plus ER to simulate AMRI. Joint motion was measured using optical trackers with the knee intact, after superficial MCL (sMCL) and deep MCL (dMCL) transection, and after AM reconstruction of the sMCL and dMCL with semitendinosus autografts. The posteromedial capsule (PMC)/posterior oblique ligament (POL) was then transected to induce a grade 3 medial injury, and kinematic measurements were repeated afterward and again after removing the grafts. Laxity changes were examined using repeated-measures analysis of variance and post-testing. Results: sMCL and dMCL deficiency increased valgus, ER, and AMRI laxities. These laxities did not differ from native values after AM reconstruction. Additional PMC/POL deficiency did not increase these laxities significantly but did increase internal rotation laxity near knee extension; this was not controlled by AM reconstruction. Conclusion: AM reconstruction eliminated AMRI after transection of the dMCL and sMCL, and also eliminated AMRI after additional PMC/POL transection. Clinical Relevance: Many MCL injuries occur in combination with ACL injuries, causing AMRI. These injuries may rupture the AM capsule and dMCL. Unaddressed MCL deficiency leads to an increased ACL reconstruction failure rate. A dMCL construct oriented anterodistally across the medial joint line, along with an sMCL graft, can restore native knee ER laxity. PMC/POL lesions did not contribute to AMRI.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

“…A dMCL graft has also been reported as part of anatomic 3-strand reconstruction, which was found to restore native ER. 25 …”

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

“…It has been shown that 3-strand (sMCL + dMCL + POL) reconstruction can restore native knee stability. 25 …”

mentioning

confidence: 99%

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Medial Collateral Ligament Reconstruction for Anteromedial Instability of the Knee: A Biomechanical Study In Vitro

et al. 2022

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A novel minimally invasive nonanatomical single‐bundle medial collateral ligament reconstruction technique with a short isometric construct Achilles tendon allograft: A surgical description with clinical and radiological outcomes in multiligament knee injury patients

Minator Sajjadi,

Mirahmadi,

Alizad

et al. 2024

J. exp. orthop.

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PurposeMultiligament knee injuries (MLKIs) involve various ligaments in the knee. Current double‐bundle anatomical reconstructions of the medial collateral ligament (MCL) increase the level of technical complexity, often resulting in the establishment of numerous bone tunnels and different fixation points with additional hardware. To overcome these limitations, we proposed a novel minimally invasive nonanatomical MCL reconstruction with one tibial tunnel in the metaphysis using Achilles allograft in the MLKI setting.MethodsIn a retrospective study, we enroled 24 patients with MLKIs who underwent a new single‐strand short isometric construct (SIC) nonanatomical MCL reconstruction during 2020 and 2021. We fixed an Achilles allograft in one tunnel in the distal femur on the medial epicondyle and one tunnel in the metaphyseal part of the tibia using interference screws at 2 cm below the joint line between the anatomical insertion of the superficial MCL and the posterior oblique ligament. The patients underwent clinical and radiological assessment at the last follow‐up, 1–2 years after the operation, including valgus stress radiographs, range of motion (ROM), Lysholm and International Knee Documentation Committee (IKDC) scores.ResultsThe mean postoperative IKDC score was 77.8 (range, 50.1–86.6). The mean Lysholm score was 84.1 ± 11.9 (range, 96–59). The medial knee widening difference (i.e., mean side‐to‐side difference under valgus stress x‐ray) was measured to be 1.2 mm on average. Only two patients (8%) had ROM limitation of 20° in knee flexion, one of which had surgery failure. Results showed a significant statistical difference between the patients' outcomes according to the number of involved ligaments.ConclusionsThis novel SIC‐like technique with a single tibial metaphyseal tunnel demonstrated satisfactory patient‐reported outcome measures, valgus stress radiographs, ROM and a low rate of knee stiffness and graft failure. While the number of injured ligaments in MLKI patients significantly influenced the outcomes, the results remained acceptable across all patients.Level of EvidenceLevel IV.

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Isometry of anteromedial reconstructions mimicking the deep medial collateral ligament depends on the femoral insertion

Behrendt,

Robinson,

Herbst

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeThis study aimed to investigate the length change patterns of the native deep medial collateral ligament (dMCL) and potential anteromedial reconstructions (AMs) that might be added to a reconstruction of the superficial MCL (sMCL) to better understand the control of anteromedial rotatory instability (AMRI).MethodsInsertion points of the dMCL and potential AM reconstructions were marked with pins (tibial) and eyelets (femoral) in 11 cadaveric knee specimens. Length changes between the pins and eyelets were then tested using threads in a validated kinematics rig with muscle loading of the quadriceps and iliotibial tract. Between 0° and 100° knee flexion, length change pattern of the anterior, middle and posterior part of the dMCL and simulated AM reconstructions were analysed using a rotary encoder. Isometry was tested using the total strain range (TSR).ResultsThe tibiofemoral distance of the anterior dMCL part lengthened with flexion (+12.7% at 100°), whereas the posterior part slackened with flexion (−12.9% at 100°). The middle part behaved almost isometrically (maximum length: +2.8% at 100°). Depending on the femoral position within the sMCL footprint, AM reconstructions resulted in an increase in length as the knee flexed when a more centred position was used, irrespective of the tibial attachment position. Femoral positioning in the posterior aspect of the sMCL footprint exhibited <4% length change and was slightly less tight in flexion (min TSR = 3.6 ± 1.5%), irrespective of the tibial attachment position.ConclusionThe length change behaviour of potential AM reconstructions in a functionally intact knee is mainly influenced by the position of the femoral attachment, with different tibial attachments having a minimal effect on length change. Surgeons performing AM reconstructions to control AMRI would be advised to choose a femoral graft position in the posterior part of the native sMCL attachment to optimise graft length change behaviour. Given the high frequency of MCL injuries, sufficient restoration of AMRI is essential in isolated and combined ligamentous knee injuries.Level of EvidenceThere is no level of evidence as this study was an experimental laboratory study.

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A Triple-Strand Anatomic Medial Collateral Ligament Reconstruction Restores Knee Stability More Completely Than a Double-Strand Reconstruction: A Biomechanical Study In Vitro

Cited by 19 publications

References 45 publications

Medial Collateral Ligament Reconstruction for Anteromedial Instability of the Knee: A Biomechanical Study In Vitro

Medial Collateral Ligament Reconstruction for Anteromedial Instability of the Knee: A Biomechanical Study In Vitro

A novel minimally invasive nonanatomical single‐bundle medial collateral ligament reconstruction technique with a short isometric construct Achilles tendon allograft: A surgical description with clinical and radiological outcomes in multiligament knee injury patients

Isometry of anteromedial reconstructions mimicking the deep medial collateral ligament depends on the femoral insertion

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