Primary reconstruction of the medial collateral ligament in combined injury of the medial collateral and anterior cruciate ligaments

Frölke, Jan Paul M.; Oskam, Jacques; Vierhout, P.A.M.

doi:10.1007/s001670050081

Cited by 53 publications

(29 citation statements)

References 13 publications

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“…Because of the muscle atrophy, derangement, and scar healing, the high grade MCL injury could not gain a satisfactory clinical result as good as low grade MCL injury without concomitant structure injury [24]. So some authors advocated acute surgical repair or reconstruction for cases with grade III or above laxity [13, 16, 25]. Dong et al put forward similar point that 3° MCL injury could hardly yield a satisfactory result if only with revision scarring and incomplete healing.…”

Section: Discussionmentioning

confidence: 99%

An anatomical-like triangular-vector ligament reconstruction for the medial collateral ligament and the posterior oblique ligament injury with single femoral tunnel: a retrospective study

Xu¹,

Kang²,

Zhang³

et al. 2017

J Orthop Surg Res

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BackgroundThe purpose of this study was to evaluate the clinical outcomes of anatomical-like triangular-vector ligament reconstruction (TLR) in treating the combined injury of medial collateral ligament (MCL) and posterior oblique ligament (POL).MethodsDuring July 2013 to May 2014, 26 patients who received anatomical-like TLR were included into this study. All patients received clinical physical examination, imaging examination, and knee joint function score both preoperative and follow-up. The stability of the medial structure of the knee joint was examined by physical examination and imaging evaluation, including excessive knee medial opening (EKMO) and tibial external rotation angle (TERA). The function of the knee was evaluated by the subjective questionnaire, including Lysholm, Tegner, and IKDC score. SPSS software was used for statistics analysis.ResultsThe mean follow-up time exceeds 24 months. Two patients occurred with serious heterotopic ossification, and one patient received revision because of screw breakage. EKMO over the contralateral state at 0° decreased from 9.76 ± 2.76 mm to 2.79 ± 1.02 mm with statistical significance (P < .001) and 10.32 ± 2.75 mm decreased to 3.13 ± 0.85 mm at 30° (P < .001). Meanwhile, TERA significantly decreased from 53.38 ± 6.71° to 27.15 ± 4.92° (P < .001). The postoperative Lysholm, Tegner, and IKDC score were superior to preoperative with statistical significance (P < .001).ConclusionsAnatomical-like TLR can reconstruct the graft to cover the insertions which can regain anatomic form and function with a cramped space. Not only the valgus stability and rotational stability can be restored obviously at follow-up but also the usage of implantation can be reduced, decreasing the incidence rate of allergy and saving costs.

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Section: Discussionmentioning

confidence: 99%

An anatomical-like triangular-vector ligament reconstruction for the medial collateral ligament and the posterior oblique ligament injury with single femoral tunnel: a retrospective study

Xu¹,

Kang²,

Zhang³

et al. 2017

J Orthop Surg Res

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show abstract

“…Fetto and Marshall 2 demonstrated that 79% of mixed could be performed if conservative treatment of this ligament had failed. 26 Others prefer to decide whether to treat the medial structures operatively depending on the extent of injury to the medial side of the knee. In a study by Shirakura and colleagues a group of 14 ACL/MCL injuries with grade III MCL tears that demonstrated anterior subluxation of the medial tibial plateau during laxity tests under anesthesia received suture repair with ligament stapling of the medialsided structures without ACL reconstruction.…”

Section: Combined Injuriesmentioning

confidence: 99%

A Review of Surgical and Nonsurgical Outcomes of Medial Knee Injuries

Smyth

Koh

2015

Sports Medicine and Arthroscopy Review

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Medial-sided knee injuries can result in pain, instability, and loss of function. Many clinical studies have been written on the treatment of medial-sided knee injuries; however, the vast majority are isolated case series of surgical or nonoperative treatment regimens, and only a few randomized prospective clinical trials can be found in the literature that compare different treatment modalities. Comparison of these treatments is challenging due to the variety of medial-sided structures that can be involved, the multiple different approaches to treatment, and the variability of how objective and subjective clinical outcomes are reported. In this paper we report on the injuries by extent and type of anatomic structures damaged including partial medial-sided injuries, completed isolated medial-sided knee injuries, and combined injuries. In general, most authors concur that isolated partial or complete medial collateral ligament (MCL) injuries can be treated nonoperatively with a brace and early motion with good clinical outcomes. Prospective, randomized trials support nonoperative treatment of the MCL in combined anterior cruciate ligament-MCL injuries. Knee dislocations and posterior medial corner injuries appear to have better results with surgical management including reconstruction. Multiple reconstructive techniques have been described for chronic injuries but it is difficult to compare their results.

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“…However, at longer term (52 weeks), the advantages of the MCL repair on the biomechanical properties of the FMTC disappeared [30,237]. Therefore, it is apparent that only reconstruction of the ACL is necessary after a combined injury due to the important role the ACL plays in maintaining valgus instability.…”

Section: Introductionmentioning

confidence: 99%

Role of biomechanics in the understanding of normal, injured, and healing ligaments and tendons

Jung

Fisher

Woo

2009

BMC Sports Sci Med Rehabil

108

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Ligaments and tendons are soft connective tissues which serve essential roles for biomechanical function of the musculoskeletal system by stabilizing and guiding the motion of diarthrodial joints. Nevertheless, these tissues are frequently injured due to repetition and overuse as well as quick cutting motions that involve acceleration and deceleration. These injuries often upset this balance between mobility and stability of the joint which causes damage to other soft tissues manifested as pain and other morbidity, such as osteoarthritis.The healing of ligament and tendon injuries varies from tissue to tissue. Tendinopathies are ubiquitous and can take up to 12 months for the pain to subside before one could return to normal activity. A ruptured medial collateral ligament (MCL) can generally heal spontaneously; however, its remodeling process takes years and its biomechanical properties remain inferior when compared to the normal MCL. It is also known that a midsubstance anterior cruciate ligament (ACL) tear has limited healing capability, and reconstruction by soft tissue grafts has been regularly performed to regain knee function. However, long term follow-up studies have revealed that 20-25% of patients experience unsatisfactory results. Thus, a better understanding of the function of ligaments and tendons, together with knowledge on their healing potential, may help investigators to develop novel strategies to accelerate and improve the healing process of ligaments and tendons.With thousands of new papers published in the last ten years that involve biomechanics of ligaments and tendons, there is an increasing appreciation of this subject area. Such attention has positively impacted clinical practice. On the other hand, biomechanical data are complex in nature, and there is a danger of misinterpreting them. Thus, in these review, we will provide the readers with a brief overview of ligaments and tendons and refer them to appropriate methodologies used to obtain their biomechanical properties. Specifically, we hope the reader will pay attention to how the properties of these tissues can be altered due to various experimental and biologic factors. Following this background material, we will present how biomechanics can be applied to gain an understanding of the mechanisms as well as clinical management of various ligament and tendon ailments. To conclude, new technology, including imaging and robotics as well as functional tissue engineering, that could form novel treatment strategies to enhance healing of ligament and tendon are presented.

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Primary reconstruction of the medial collateral ligament in combined injury of the medial collateral and anterior cruciate ligaments

Cited by 53 publications

References 13 publications

An anatomical-like triangular-vector ligament reconstruction for the medial collateral ligament and the posterior oblique ligament injury with single femoral tunnel: a retrospective study

An anatomical-like triangular-vector ligament reconstruction for the medial collateral ligament and the posterior oblique ligament injury with single femoral tunnel: a retrospective study

A Review of Surgical and Nonsurgical Outcomes of Medial Knee Injuries

Role of biomechanics in the understanding of normal, injured, and healing ligaments and tendons

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