Evaluation and Treatment of Medial Collateral Ligament and Medial-sided Injuries of the Knee

Jacobson, Kurt E.; Somda, Frédéric

doi:10.1097/01.jsa.0000212305.47323.58

Cited by 94 publications

(77 citation statements)

References 41 publications

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“…[7][8][9] However, only static anatomical information is provided and so there is potential to underestimate the true extent of the injury. 10 In TKA, assessment of laxity is a routine component of many soft tissue balancing techniques and is often used to determine the need for a soft tissue release, 11,12 particularly for large deformities that are judged to be uncorrectable. Attempts have been made to categorise collateral laxity, for example Krackow's classification of medial ligament tightness, 13 but this assumes that all clinicians have similar examination methods and are able to reliably judge knee alignment.…”

Section: Introductionmentioning

confidence: 99%

Standardising the clinical assessment of coronal knee laxity

Clarke

Wilson

Wearing

et al. 2012

Proc Inst Mech Eng H

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Clinical laxity tests are used for assessing knee ligament injuries and for soft tissue balancing in total knee arthroplasty. This study reports the development and validation of a quantitative technique of assessing collateral knee laxity through accurate measurement of potential variables during routine clinical examination. The hypothesis was that standardisation of a clinical stress test would result in a repeatable range of laxity measurements. Non-invasive infrared tracking technology with kinematic registration of joint centres gave real-time measurement of both coronal and sagittal mechanical tibiofemoral alignment. Knee flexion, moment arm and magnitude of the applied force were all measured and standardised. Three clinicians then performed six knee laxity examinations on a single volunteer using a target moment of 18 Nm. Standardised laxity measurements had small standard deviations (within 1.1°) for each clinician and similar mean values between clinicians, with the valgus laxity assessment (mean of 3°) being slightly more consistent than varus (means of 4° or 5°). The manual technique of coronal knee laxity assessment was successfully quantified and standardised, leading to a narrow range of measurements (within the accuracy of the measurement system). Minimising the subjective variables of clinical examination could improve current knowledge of soft tissue knee behaviour.

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Section: Introductionmentioning

confidence: 99%

Standardising the clinical assessment of coronal knee laxity

Clarke

Wilson

Wearing

et al. 2012

Proc Inst Mech Eng H

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“…1,2 This knowledge plus the desire to restore full (ideally normal) functions to all injured structures after a combined injury has provoked many different attempts over the years to improve on untreated repairs of the MCL. [3][4][5][6][7][8] To date, none have improved on the nonoperative management of the MCL.…”

mentioning

confidence: 99%

Healing ligament mechanical properties are improved by repair with interpositional allografts but not by concomitant treatment with hyaluronic acid

Thornton¹,

Shao²,

Kuchison³

et al. 2009

Journal Orthopaedic Research

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Healing ligaments have inferior mechanical properties compared to normal ligaments during early healing intervals. The purpose of this study was to investigate if in vivo ligament repair with an interpositional allograft and treatment with hyaluronic acid (HA) would improve the mechanical properties of a medial collateral ligament (MCL) healing from a gap injury. Twenty rabbits were assigned equally to either a donor or recipient group. A gap injury of the MCL was created in both hindlimbs of 10 recipient animals. The right hindlimb was treated with allograft plus HA while the left hindlimb was treated with allograft only. Low-load and high-load mechanical properties, including laxity, relaxation and failure, and histology were evaluated after 6 weeks of healing. Mechanical results were compared to previously published normal MCL and MCL gap scar data. MCL allografts had greater initial force during cyclic relaxation testing and maximum force during failure testing than MCL scars, but were weaker than normal MCLs. Failure stress was the only parameter to demonstrate a statistically significant effect of treatment with HA on the allografts. However, the failure stress of the HA-treated MCL allografts was not different than MCL scars and was less than normal MCLs. In conclusion, interpositional allografts could enhance some mechanical properties of ligament healing but HA, in the way we applied it, did not produce an obvious improvement. ß

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“…Existen autores que describen el tratamiento no quirúrgico de ambas lesiones como una op- ción aceptable (29,30) . Otros autores consideran que solo la reconstrucción aislada del LCA es suficiente para restaurar la estabilidad en lesiones asociadas de LCA y LCM de grado III (14,31) .…”

Section: Discussionunclassified

Retorno al deporte posterior a una reconstrucción simultánea de ligamento cruzado anterior y ligamento colateral medial de grado III en periodo subagudo

Bertona¹,

Zicaro²,

González-Viescas³

et al. 2018

REACA

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RESUMENIntroducción: las lesiones asociadas del ligamento cruzado anterior (LCA) y del ligamento colateral medial (LCM) corresponden al 20% de la lesiones ligamentosas de la rodilla. El tratamiento conservador del LCM y la reconstrucción quirúrgica del LCA son generalmente recomendados. En deportistas, el tratamiento conservador del LCM puede conducir a inestabilidad medial crónica. El manejo óptimo de deportistas con lesiones combinadas de LCA-LCM continúa siendo controvertido. El objetivo de este trabajo es analizar los resultados funcionales y el nivel deportivo alcanzado en el postoperatorio de una serie de pacientes tratados con reconstrucción simultanea de LCA y LCM con un seguimiento mínimo de 2 años. Material y métodos: un total de 20 atletas con reconstrucciones agudas simultáneas de LCA y LCM de grado III fueron tratados entre marzo de 2006 y enero de 2014. El tiempo mínimo de seguimiento fue de 24 meses. Se evaluaron los resultados funcionales subjetivos (International Knee Documentation Committee -IKDC-, Lysholm), rango de movilidad, estabilidad anteromedial y rotacional (Lachmann, pivot shift, estrés valgo). Se registró la capacidad de retorno al deporte (Tegner) y el nivel alcanzado. ABSTRACT IntroducciónEl ligamento colateral medial (LCM) es la estructura ligamentosa de la rodilla más frecuentemente lesionada (1) . Anatómicamente se diferencia en LCM superficial (LCMs), LCM profundo (LCMp) y ligamento posterior oblicuo (LPO) (2) . Dependiendo del porcentaje de compromiso ligamentoso y la inestabilidad medial de la rodilla, las lesiones del LCM se dividen en los grados I, II y III, correspondiendo las lesiones de grado III a la disrupción completa de las fibras ligamentosas (3) . Las lesiones de grado III están asociadas a otras lesiones ligamentosas en el 80% de los casos. De estas lesiones asociadas, el 95% corresponde a lesiones del ligamento cruzado anterior (LCA) (4) . El mecanismo de lesión implica la carga en valgo de la rodilla, rotación externa o un vector de fuerza combinado que requiere la flexión de la rodilla (5)(6)(7) . El manejo de las lesiones de LCM depende del grado del compromiso ligamentoso. En lesiones asiladas de grado I y II el tratamiento no quirúr-gico, con rehabilitación funcional precoz, es ampliamente aceptado. En lesiones de LCM de grado III, especialmente en asociación con lesión de LCA, el tratamiento es controvertido (8)(9)(10)(11)(12) . Múltiples autores consideran que el tratamiento aislado del LCA en lesiones asociadas de LCA y LCM es suficiente para restaurar la estabilidad de la rodilla (13)(14)(15) . Sin embargo, existe evidencia de que en lesiones asociadas de LCA y LCM de grado III, la reparación aislada del LCA se relaciona con mayor carga mecánica sobre el LCA reconstruido, aumentando el riesgo de falla y de inestabilidad crónica sintomática en valgo de la rodilla (16)(17)(18) . La reconstrucción simultánea de LCA y LCM en lesiones asociadas ha sido descrita con buenos resultados funcionales (8,19,20) . Resultados: todos los pacientes mejoraron significat...

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Evaluation and Treatment of Medial Collateral Ligament and Medial-sided Injuries of the Knee

Cited by 94 publications

References 41 publications

Standardising the clinical assessment of coronal knee laxity

Standardising the clinical assessment of coronal knee laxity

Healing ligament mechanical properties are improved by repair with interpositional allografts but not by concomitant treatment with hyaluronic acid

Retorno al deporte posterior a una reconstrucción simultánea de ligamento cruzado anterior y ligamento colateral medial de grado III en periodo subagudo

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