Open Anatomic Reconstruction of the Medial Collateral Ligament and Posteromedial Corner

Prince, Matthew R.; Blackman, Andrew J.; King, Alexander H.; Stuart, Michael J.; Levy, Bruce A.

doi:10.1016/j.eats.2015.08.013

Cited by 21 publications

(10 citation statements)

References 18 publications

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“…19,24 The superficial MCL (sMCL), deep MCL, and POL are the 3 most important structures on the medial knee in providing both primary and secondary static stabilization roles for valgus, external rotation, and internal rotation stability of the knee. 10,15,18,22,23,[27][28][29] In 2007, LaPrade et al 13 published their qualitative and quantitative descriptions of the attachment sites of the main medial knee structures and their relationships to pertinent osseous landmarks. The work by LaPrade 13 also shed light on the biomechanical function and load sharing between the sMCL and the POL.…”

Section: In-depthmentioning

confidence: 99%

A Biomechanical Comparison of the LaPrade Technique Versus a Novel Technique for Reconstruction of Medial-Sided Knee Injuries

et al. 2022

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Background: Medial-sided knee injuries can lead to symptomatic valgus laxity or anteromedial rotatory instability and may require surgery, particularly in the setting of cruciate tears and tibial-sided medial collateral ligament (MCL) avulsions. The LaPrade (LP) technique utilizes 2 free grafts to reconstruct the superficial MCL (sMCL) and the posterior oblique ligament (POL). An alternative MCL reconstruction devised by the senior author comprises an anatomic single-bundle reconstruction using a free graft to reconstruct the sMCL with advancement and imbrication of the posteromedial capsule/POL (MCL anatomic reconstruction with capsular imbrication [MARCI] technique). These techniques have not been biomechanically compared with one another. Purpose: To identify if one of these reconstruction techniques better restores valgus and rotational medial knee stability throughout the range of motion. Study Design: Controlled laboratory study. Methods: A total of 20 fresh-frozen, male (mean age, 43.7 years [range, 20-63 years]), midfemur-to-toe-matched cadaveric knees were utilized. All reconstructions were performed by a single fellowship-trained sports medicine surgeon. Left and right specimens within matched pairs were randomized to 1 of the 2 treatment groups: LP or MARCI. Each specimen was tested in 3 phases: (1) intact knee, (2) destabilized (MCL and POL completely severed), and (3) reconstructed (post-LP or post-MARCI reconstruction). We quantified valgus angulation defined by medial joint line opening, as well as internal and external tibial rotation at 0°, 20°, 30°, 60°, and 90° of knee flexion under applied external moments/torques at each phase. Results: There were significant differences between the MARCI and LP reconstruction groups in valgus stability compared with the intact state ( P = .021), with the MARCI reconstruction more closely approximating the intact knee. There was no overall difference between the MARCI and LP reconstruction techniques for internal rotation ( P = .163), with both closely resembling the intact state. For external rotation, the effect of the reconstruction technique was dependent on the knee flexion angle ( P < .001). At the highest angles, there were no differences between reconstructions; however, for lower knee flexion angles, the MARCI technique more closely resembled the intact state. Conclusion: Although both techniques improved knee stability compared with destabilized conditions, the MARCI technique better approximated intact stability during valgus at knee flexion angles from 0° to 90° and external rotation loads at knee flexion angles ≤30° in a cadaveric model. Clinical Relevance: The MARCI technique provides an alternative option to improve valgus stability throughout the range of motion. It utilizes a POL advancement without the potential limitations seen in the LP technique, such as multiple tunnel complexity and collision, particularly in the multiple ligament–injured knee.

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Section: In-depthmentioning

confidence: 99%

A Biomechanical Comparison of the LaPrade Technique Versus a Novel Technique for Reconstruction of Medial-Sided Knee Injuries

et al. 2022

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“…1 El ligamento colateral medial profundo es un estabilizador secundario de las fuerzas en valgo; a 60 o de flexión la porción menisco tibial es la que proporciona mayor estabilidad, en el resto de los grados de flexión su mayor estabilidad será dada por la porción menisco femoral. 1,5 La incidencia de las lesiones del ligamento colateral medial van desde 0.24 en población general hasta 18.65 por cada 1,000 habitantes en grupos de personas que se encuentran en un ámbito deportivo, siendo de 7.27 en la serie de Roach y colaboradores para las lesiones aisladas del LCM y de 5.36 para la población femenina. 1,4,6 Las lesiones del LCM según la Asociación Médica Americana (AMC por sus siglas en inglés), se dividen en tres grados: el grado I se presenta con hipersensibilidad, pero sin hiperlaxitud.…”

Section: Introductionunclassified

Prevalencia de lesión del ligamento colateral medial de la rodilla valorada por resonancia magnética

Aguirre-Rodríguez¹,

Valdés-Montor²,

Valero-González³

et al. 2021

Acta Ortopédica Mexicana

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“…In the past several decades, PMC injuries have been managed in different ways including surgical or non-surgical treatment [ 7 ], and there is still controversy regarding their treatment. However, in recent years, numerous orthopedic surgeons have focused on surgical management for PMC-involved high-energy multiligamentous knee injuries [ 7 , 10 – 13 ].…”

Section: Introductionmentioning

confidence: 99%

Influence of posteromedial corner injuries on clinical outcome and second-look arthroscopic findings after allograft transtibial anterior cruciate ligament reconstruction

Yoo

Park

Kwon

2020

Knee Surg & Relat Res

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Background The purpose of this study was to evaluate the influence of posterior medial corner (PMC) injuries on clinical outcome and second-look arthroscopic findings after anterior cruciate ligament (ACL) reconstruction. Methods Seventy-eight consecutive patients underwent a second-look arthroscopic surgery after ACL reconstruction and magnetic resonance imaging (MRI) examination of the PMC. The patients were divided into a PMC intact group ( n = 42) and a PMC injured group ( n = 36). The stability and clinical outcomes were evaluated using the Lachman test, pivot-shift test, a KT-2000 arthrometer, and the Lysholm knee scoring scale. Graft tension and synovial coverage were evaluated in second-look arthroscopy. Results The clinical function showed no significant differences regarding PMC injury. Although the graft tendon tension revealed no significant differences ( p = 0.141), the second-look arthroscopic findings indicated that the PMC intact group showed better synovial coverage compared to the PMC injured group ( p = 0.012). Conclusion Patients who injured the PMC had poor synovial coverage as assessed by second-look arthroscopic findings after transtibial ACL reconstruction, even though clinical outcomes and stability showed no significant differences.

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Open Anatomic Reconstruction of the Medial Collateral Ligament and Posteromedial Corner

Cited by 21 publications

References 18 publications

A Biomechanical Comparison of the LaPrade Technique Versus a Novel Technique for Reconstruction of Medial-Sided Knee Injuries

A Biomechanical Comparison of the LaPrade Technique Versus a Novel Technique for Reconstruction of Medial-Sided Knee Injuries

Prevalencia de lesión del ligamento colateral medial de la rodilla valorada por resonancia magnética

Influence of posteromedial corner injuries on clinical outcome and second-look arthroscopic findings after allograft transtibial anterior cruciate ligament reconstruction

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