Medial Collateral Ligament Reconstruction and Repair Show Similar Improvement in Outcome Scores, But Repair Shows Higher Rates of Knee Stiffness and Failure: A Systematic Review

Mowers, Colton C.; Jackson, Garrett R.; Condon, Joshua J.; Dhillon, Nireet; Brusalis, Christopher M.; Khan, Zeeshan A.; Batra, Anjay; Jawanda, Harkirat; Mameri, Enzo S.; Kaplan, Daniel J.; Knapik, Derrick M.; Verma, Nikhil N.; Chahla, Jorge

doi:10.1016/j.arthro.2023.03.002

Cited by 12 publications

(9 citation statements)

References 29 publications

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“…Repair and reconstruction of posteromedial corner injuries result in good patient-reported outcomes and knee stability [15,20,33], while high failure rates remain a concern, with reported rates of persistent and recurrent medial instability ranging between 10% and 47% [15,19,20]. 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].…”

Section: Discussionmentioning

confidence: 99%

“…While most MCL injuries can be treated nonoperatively, certain high-grade injuries and knees with chronic medial instability require surgical treatment [26,36]. Although repair and reconstruction of these injuries results in good patient-reported outcomes and knee stability [15,20,33], failure rates range from 10% to 47% [15,19,20]. While up to one-third of posterolateral corner reconstructions failed due to an untreated varus deformity [22,32], the influence of valgus malalignment on medial-sided reconstructions has not been thoroughly investigated in recent clinical studies [6,9,27].…”

Section: Introductionmentioning

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: 99%

Section: Introductionmentioning

confidence: 99%

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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“…Most modern techniques do not use SA technology and are more invasive, achieving repair through an incision over the entire length of the MCL. 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 Furthermore, these techniques vary greatly in their time to surgery, indicated patient populations, reported outcomes, and rehabilitation protocol. Nonetheless, outcomes of MCL repair are homogenized in the literature.…”

Section: Discussionmentioning

confidence: 99%

Acute Percutaneous Repair of Medial Collateral Ligament With Suture Augmentation in the Multiligamentous Injured Knee Results in Good Stability and Low Rates of Postoperative Stiffness

Holuba,

Rilk,

Vermeijden

et al. 2023

Arthroscopy, Sports Medicine, and Rehabilitation

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“…8 The authors found, however, that MCL repair largely results in higher rates of not only knee stiffness, but also a higher 2-year failure rate, suggesting that reconstructions are advantageous. 8…”

Section: Video Transcriptmentioning

confidence: 97%

“…A recent systematic review demonstrates improved patient-reported outcomes following both MCL repair and MCL reconstruction. 8 The authors found, however, that MCL repair largely results in higher rates of not only knee stiffness, but also a higher 2-year failure rate, suggesting that reconstructions are advantageous. AOSSM checks author disclosures against the Open Payments Database (OPD).…”

Section: Video Transcriptmentioning

confidence: 97%

Tibial-Sling Triangular Medial Collateral Ligament Reconstruction With Posterior Oblique Ligament Limb

Franciozi,

Mameri,

Gracitelli

et al. 2023

Video Journal of Sports Medicine

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Background: While most medial-sided knee injuries can be managed conservatively, high-grade injuries of the posteromedial corner have been reported to have less than optimal outcomes with conservative approaches, resulting in residual valgus and rotational instability. Consensus among experts postulates that treatment should be based on reconstructing both the superficial medial collateral ligament (sMCL) and the posterior oblique ligament (POL). We present a modified technique of a tibial-sling anatomic MCL reconstruction with a POL limb. Indications: High-grade injuries of the posteromedial corner, specifically injuries with medial joint gapping in extension or grade 3 medial-sided tears. Technique Description: The MCL is reconstructed with a semitendinosus autograft in a tibial sling, created by converging perpendicular bone tunnels at its anatomic tibial insertion, and fixed to a femoral tunnel in the isometric point just posterior and proximal to the medial epicondyle with the knee at 30° of flexion. That same single femoral tunnel will be shared by the two strands of the semitendinosus graft and a limb of gracilis autograft to reproduce the POL, passed through a tibial tunnel in the posteromedial margin of medial tibial condyle, and fixed in extension. Discussion/Conclusion: As recent evidence suggests that medial reconstruction should be preferred over repair, due to favorable complication and failure rates, we describe a technique that is both anatomic-based, reproducing the 2 main medial knee structures (sMCL, POL), and also cost-saving, with decreased need of fixation devices. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

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Medial Collateral Ligament Reconstruction and Repair Show Similar Improvement in Outcome Scores, But Repair Shows Higher Rates of Knee Stiffness and Failure: A Systematic Review

Cited by 12 publications

References 29 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

Acute Percutaneous Repair of Medial Collateral Ligament With Suture Augmentation in the Multiligamentous Injured Knee Results in Good Stability and Low Rates of Postoperative Stiffness

Tibial-Sling Triangular Medial Collateral Ligament Reconstruction With Posterior Oblique Ligament Limb

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