Management of Medial Collateral Ligament Laxity

Jl, Cameron; Saha, Sandipan

doi:10.1016/s0030-5898(20)31935-0

Cited by 19 publications

(3 citation statements)

References 8 publications

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“…These findings suggest that realigning osteotomies might be an efficient procedure to reduce the tensile forces acting on the medial side of the knee rather than a soft tissue ligament reconstruction. Consistent with these biomechanical data, Cameron et al [5] have clinically shown that a varus producing distal femoral osteotomy improved gait pattern and subjective knee function in patients with combined chronic medial instability and valgus malalignment. In fact, 34 of 35 patients (97%) demonstrated a loss of valgus thrust during single-leg stance phase [3,24].…”

Section: Discussionmentioning

confidence: 72%

“…Beside technical issues [4,13,38] and missed rotatory knee instability [10,15,35,37,40], valgus malalignment may account for these high failure rates [27,32], as posteromedial soft tissue reconstructions may be subjected to excessive tensile forces in these patients [17,27,31]. Such repetitive forces on a reconstructed ligament in subjects with relevant osseous malalignment might cause secondary graft insufficiency or failure [5,24,27]. In 2006, Noyes et al [22] postulated that 37% of their posterolateral corner reconstructions failed by an untreated varus malalignment of 4-6°.…”

Section: Discussionmentioning

confidence: 99%

“…In 2006, Noyes et al [22] postulated that 37% of their posterolateral corner reconstructions failed by an untreated varus malalignment of 4–6°. Although there are no studies providing a systematic failure analysis in knees with persistent or recurrent medial instability, a similar phenomenon may also be seen in valgus knees with medial‐sided injuries and reconstructions [5, 17, 24, 27].…”

Section: Discussionmentioning

confidence: 99%

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Valgus malalignment causes increased forces on a medial collateral ligament reconstruction under dynamic valgus loading: A biomechanical study

Peez,

Deichsel,

Zderic

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeTo investigate the forces on a medial collateral ligament (MCL) reconstruction (MCLR) relative to the valgus alignment of the knee.MethodsEight fresh‐frozen human cadaveric knees were subjected to dynamic valgus loading at 400 N using a custom‐made kinematics rig. After resection of the superficial medial collateral ligament, a single‐bundle MCLR with a hamstring tendon autograft was performed. A medial opening wedge distal femoral osteotomy was performed and fixed with an external fixator to gradually adjust the alignment in 5° increments from 0° to 10° valgus. For each degree of valgus deformity, the resulting forces acting on the MCLR were measured through a force sensor and captured in 15° increments from 0° to 60° of knee flexion.ResultsIrrespective of the degree of knee flexion, increasing valgus malalignment resulted in significantly increased forces acting on the MCLR compared to neutral alignment (p < 0.05). Dynamic loading at 5° valgus resulted in increased forces on the MCLR at all flexion angles ranging between 16.2 N and 18.5 N (p < 0.05 from 0° to 30°; p < 0.01 from 45° to 60°). A 10° valgus malalignment further increased the forces on the MCLR at all flexion angles ranging between 29.4 N and 40.0 N (p < 0.01 from 0° to 45°, p < 0.05 at 60°).ConclusionValgus malalignment of the knee caused increased forces acting on the reconstructed MCL. In cases of chronic medial instabilities accompanied by a valgus deformity ≥ 5°, a realigning osteotomy should be considered concomitantly to the MCLR to protect the graft and potentially reduce graft failures.Level of EvidenceLevel III.

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Section: Discussionmentioning

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Valgus malalignment causes increased forces on a medial collateral ligament reconstruction under dynamic valgus loading: A biomechanical study

Peez,

Deichsel,

Zderic

et al. 2024

Knee surg. sports traumatol. arthrosc.

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Collateral ligament strain is linearly related to coronal lower limb alignment: A biomechanical study

Peez,

Hägerich,

Ruhl

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeThe purpose of this study was to analyse the influence of coronal lower limb alignment on collateral ligament strain.MethodsTwelve fresh‐frozen human cadaveric knees were used. Long‐leg standing radiographs were obtained to assess lower limb alignment. Specimens were axially loaded in a custom‐made kinematics rig with 200 and 400 N, and dynamic varus/valgus angulation was simulated in 0°, 30°, and 60° of knee flexion. The changes in varus/valgus angulation and strain within different fibre regions of the collateral ligaments were captured using a three‐dimensional optical measuring system to examine the axis‐dependent strain behaviour of the superficial medial collateral ligament (sMCL) and lateral collateral ligament (LCL) at intervals of 2°.ResultsThe LCL and sMCL were exposed to the highest strain values at full extension (p < 0.001). Regardless of flexion angle and extent of axial loading, the ligament strain showed a strong and linear association with varus (all Pearson's r ≥ 0.98; p < 0.001) and valgus angulation (all Pearson's r ≥ −0.97; p < 0.01). At full extension and 400 N of axial loading, the anterior and posterior LCL fibres exceeded 4% ligament strain at 3.9° and 4.0° of varus, while the sMCL showed corresponding strain values of more than 4% at a valgus angle of 6.8°, 5.4° and 4.9° for its anterior, middle and posterior fibres, respectively.ConclusionThe strain within the native LCL and sMCL was linearly related to coronal lower limb alignment. Strain levels associated with potential ultrastructural damages to the ligaments of more than 4% were observed at 4° of varus and about 5° of valgus malalignment, respectively. When reconstructing the collateral ligaments, an additional realigning osteotomy should be considered in cases of chronic instability with a coronal malalignment exceeding 4°–5° to protect the graft and potentially reduce failures.Level of EvidenceThere is no level of evidence as this study was an experimental laboratory study.

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Avoiding and Managing Complications of Collateral Ligament Surgery of the Knee

Paulos

Mendez²

2009

Complications in Knee and Shoulder Surgery

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Management of Medial Collateral Ligament Laxity

Cited by 19 publications

References 8 publications

Valgus malalignment causes increased forces on a medial collateral ligament reconstruction under dynamic valgus loading: A biomechanical study

Valgus malalignment causes increased forces on a medial collateral ligament reconstruction under dynamic valgus loading: A biomechanical study

Collateral ligament strain is linearly related to coronal lower limb alignment: A biomechanical study

Avoiding and Managing Complications of Collateral Ligament Surgery of the Knee

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