Abstract:The posterior oblique ligament (POL) is the predominant ligamentous structure on the posterior medial corner of the knee joint. A thorough understanding of the anatomy, biomechanics, diagnosis, treatment and rehabilitation of POL injuries will aid orthopaedic surgeons in the management of these injuries. The resulting rotational instability, in addition to valgus laxity, may not be tolerated by athletes participating in pivoting sports. The most common mechanism of injury – accounting for 72% of cases – is rel… Show more
“…These results are in line with the literature. 7,28 Griffith et al 10 did not find a significant result for medial stabilization during valgus stress with the POL, but this could be explained by a nonconsensus description of the POL in the literature, which may lead to a variation in protocol. These findings also show that the effects of the medial HS are predominant in joint ranges for which the POL is the main valgus stabilizer of the knee.…”
Section: Discussionmentioning
confidence: 97%
“…This process was repeated on each knee after successively sectioning the superficial MCL (sMCL), the deep MCL (dMCL), and then the POL (on their tibial insertion) to reproduce the most frequent pathophysiological sequence. 7 The ACL and PCL were always left intact during the experimental protocol (Figure 2).…”
Background: Multiligament knee injuries involving the medial side are common. When performing surgical reconstruction, use of the medial hamstrings (HS) as grafts remains controversial in this setting. Purpose: To determine the role of the medial HS in stabilizing the valgus knee for different types of medial-sided knee injury. Study Design: Controlled laboratory study. Methods: A biomechanical study on 10 cadaveric knees was performed. Valgus load (force moment of 10 N/m) was applied at 0°, 30°, and 60° of flexion, and the resultant rotation was recorded using an optoelectronic motion analysis system. Measurements were repeated for 4 different knee states: intact knee, superficial medial collateral ligament (sMCL) injury, deep medial collateral ligament (dMCL) injury, and posterior oblique ligament (POL) injury. For each state, 4 loading conditions (+ loaded; – unloaded) of the semitendinosus (ST) and gracilis (GRA) tendons were tested: ST+/GRA+, ST+/GRA–, ST–/GRA+, and ST–/GRA–. Results: At 0° of flexion, combined unloading of the ST and GRA (ST–/GRA–) increased valgus laxity on the intact knee compared with the ST+/GRA+ condition ( P < .05). For all medial-sided injury states (isolated sMCL; combined sMCL and dMCL; and combined sMCL, dMCL, and POL damage), ST–/GRA– increased valgus laxity at 0° and 30° of flexion versus ST+/GRA+ ( P < .05 for all). The absolute value of valgus laxity increased with the severity of medial-sided ligament injury. Isolated ST unloading increased valgus laxity for the intact knee and the MCL-injured knee (combined sMCL and dMCL) at 0° of flexion ( P < .05 vs ST+/GRA+). Isolated unloading of the GRA had no effect on valgus knee stability. Conclusion: The medial HS tendons contributed to the stabilization of the knee in valgus, and this was even more important when the medial side was severely affected (POL damage). This stabilizing effect was greater between 0° and 30°, in which the POL is the main valgus stabilizer. Clinical Relevance: When deciding on graft selection for multiligament knee injury reconstruction, the surgeon should be aware of the effect of harvesting the medial HS tendon on valgus laxity.
“…These results are in line with the literature. 7,28 Griffith et al 10 did not find a significant result for medial stabilization during valgus stress with the POL, but this could be explained by a nonconsensus description of the POL in the literature, which may lead to a variation in protocol. These findings also show that the effects of the medial HS are predominant in joint ranges for which the POL is the main valgus stabilizer of the knee.…”
Section: Discussionmentioning
confidence: 97%
“…This process was repeated on each knee after successively sectioning the superficial MCL (sMCL), the deep MCL (dMCL), and then the POL (on their tibial insertion) to reproduce the most frequent pathophysiological sequence. 7 The ACL and PCL were always left intact during the experimental protocol (Figure 2).…”
Background: Multiligament knee injuries involving the medial side are common. When performing surgical reconstruction, use of the medial hamstrings (HS) as grafts remains controversial in this setting. Purpose: To determine the role of the medial HS in stabilizing the valgus knee for different types of medial-sided knee injury. Study Design: Controlled laboratory study. Methods: A biomechanical study on 10 cadaveric knees was performed. Valgus load (force moment of 10 N/m) was applied at 0°, 30°, and 60° of flexion, and the resultant rotation was recorded using an optoelectronic motion analysis system. Measurements were repeated for 4 different knee states: intact knee, superficial medial collateral ligament (sMCL) injury, deep medial collateral ligament (dMCL) injury, and posterior oblique ligament (POL) injury. For each state, 4 loading conditions (+ loaded; – unloaded) of the semitendinosus (ST) and gracilis (GRA) tendons were tested: ST+/GRA+, ST+/GRA–, ST–/GRA+, and ST–/GRA–. Results: At 0° of flexion, combined unloading of the ST and GRA (ST–/GRA–) increased valgus laxity on the intact knee compared with the ST+/GRA+ condition ( P < .05). For all medial-sided injury states (isolated sMCL; combined sMCL and dMCL; and combined sMCL, dMCL, and POL damage), ST–/GRA– increased valgus laxity at 0° and 30° of flexion versus ST+/GRA+ ( P < .05 for all). The absolute value of valgus laxity increased with the severity of medial-sided ligament injury. Isolated ST unloading increased valgus laxity for the intact knee and the MCL-injured knee (combined sMCL and dMCL) at 0° of flexion ( P < .05 vs ST+/GRA+). Isolated unloading of the GRA had no effect on valgus knee stability. Conclusion: The medial HS tendons contributed to the stabilization of the knee in valgus, and this was even more important when the medial side was severely affected (POL damage). This stabilizing effect was greater between 0° and 30°, in which the POL is the main valgus stabilizer. Clinical Relevance: When deciding on graft selection for multiligament knee injury reconstruction, the surgeon should be aware of the effect of harvesting the medial HS tendon on valgus laxity.
“…The POL is an important restraint to valgus and internal rotation in extension and early flexion angles (0–30 degrees). 1 12 29 Additionally, the POL and the posteromedial joint capsule act as secondary restraints to anterior and posterior tibial translation, supporting the cruciate ligaments. 30 31 The OPL plays an important role in preventing knee hyperextension and the development of genu recurvatum.…”
Section: Biomechanics Of Posteromedial Corner and Concepts Of Instabi...mentioning
confidence: 99%
“…2 34 A typical mechanism of injury involving the components of the PMC is a trauma with combined force vector of valgus loading and external tibia rotation in knee flexion that can occur in sporting activities such as football, skiing, and ice hockey. 3 29 35 In contrast, a pure valgus force often tends to cause an isolated MCL injury. In the presence of anterior cruciate ligament (ACL) or PCL tears, the integrity of PMC structures can be an important prognostic factor to compensate the cruciate deficiency and maintain knee stability.…”
Section: Imaging Findings Of Posteromedial Corner Injuriesmentioning
The posteromedial corner (PMC) of the knee is an anatomical region formed by ligamentous structures (medial collateral ligament, posterior oblique ligament, oblique popliteal ligament), the semimembranosus tendon and its expansions, the posteromedial joint capsule, and the posterior horn of the medial meniscus. Injuries to the structures of the PMC frequently occur in acute knee trauma in association with other ligamentous or meniscal tears. The correct assessment of PMC injuries is crucial because the deficiency of these supporting structures can lead to anteromedial rotation instability or the failure of cruciate ligaments grafts. This article reviews the anatomy and biomechanics of the PMC to aid radiologists in identifying injuries potentially involving PMC components.
“…The dial test identifies anteromedial subluxation of the tibia with increasing tibial external rotation. 20 Fig 1 Preoperative radiographs of the left knee. Preoperative anteroposterior (A) and preoperative lateral view (B) radiographs of a total knee arthroplasty with well-positioned tibial and femoral components before surgery for medial collateral ligament and posterior oblique ligament reconstruction.…”
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