Role of the Medial Structures in the intact and Anterior Cruciate Ligament-Deficient Knee

Haimes, Jonathan L.; Wroble, Randall R.; Grood, Edward S.; Noyes, Frank R.

doi:10.1177/036354659402200317

Cited by 159 publications

(154 citation statements)

References 39 publications

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“…16 One group 6 found that at full extension, the MCL decreased valgus stress by about 50% while the capsule (both anterior and posterior portions) added nearly 25%, and the ACL and PCL together (but mostly the PCL) assisted by approximately 25%. Haimes et al 27 found that the superficial MCL alone had a significant restraint to knee abduction at all flexion angles except 06. As long as the superficial MCL was intact, cutting the posteromedial capsule and POL had no effect, but when the superficial MCL was sectioned, the posterior elements became more important in resisting valgus stress in the MCL-deficient knee.…”

Section: Strain Measurements Of the Tibiofemoral Jointmentioning

confidence: 94%

“…20 In full extension, positioning of all portions of the MCL prevents tibiofemoral joint valgus movement. 6,18,19,22,27 Warren et al 16 sectioned portions of the MCL and tested medial joint opening as each structure was cut. When the superficial fibers alone were cut, a significant increase in medial joint opening resulted, even with the deep ligaments, posterior capsule, ACL, and posterior cruciate ligament (PCL) intact.…”

Section: Strain Measurements Of the Tibiofemoral Jointmentioning

confidence: 99%

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Bilateral Medial Tibiofemoral Joint Stiffness in Full Extension and 20° of Knee Flexion

Aronson

Rijke

Ingersoll

2008

Journal of Athletic Training

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Context:The valgus stress test is used clinically to assess injury to the medial knee structures in 2 positions: full extension and some degree of flexion. The amount of flexion used to ''isolate'' the medial collateral ligament is not consistent in the literature, but most studies have shown that stiffness of the ligaments was consistent between the limbs.Objective: To determine (1) if the stiffness of the medial knee structures was the same bilaterally, and (2) if the stiffness was different in full extension compared with 206 of knee flexion.Design: Criterion standard, before-after design. Setting: University research laboratory.Patients or Other Participants: Both knees of 45 healthy and active volunteers (26 females, 19 males; age 5 23.2 6 3.96 years, height 5 170.6 6 7.75 cm, mass 5 74.2 6 15.14 kg) were studied.Intervention(s): A valgus force of 60 N was applied to the lateral aspect of both knees in full extension and in 206 of flexion. Main Outcome Measure(s):The slope of the force-strain line of the medial knee during a valgus force was calculated using the LigMaster arthrometer.Results: Slope means in full extension were 16.1 6 3.3 (right knee) and 15.8 6 3.1(left knee). Means for 206 of flexion were 12.2 6 3.1 (right) and 11.7 6 2.8 (left). Stiffness was greater when the knee was in full extension versus 206 of flexion (t 44 5 12.04, P , .001). No difference was noted between the slopes of the 2 knees in extension (t 44 5 0.74, P 5 .46) or in flexion (t 44 5 1.2, P 5 .27).Conclusions: These findings support the use of the contralateral knee as a control. Further, the valgus stress test should be performed in full extension and in some degree of flexion to assess the different restraining structures of the medial tibiofemoral joint.

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Section: Strain Measurements Of the Tibiofemoral Jointmentioning

confidence: 94%

Section: Strain Measurements Of the Tibiofemoral Jointmentioning

confidence: 99%

Bilateral Medial Tibiofemoral Joint Stiffness in Full Extension and 20° of Knee Flexion

Aronson

Rijke

Ingersoll

2008

Journal of Athletic Training

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“…In Warren's initial works, the superficial MCL was described as the "prime static stabilizer of the medial side of the knee" [7]. Valgus forces are resisted by the superficial MCL with the knee in the flexed position; however, it does not seem to affect medial stability at full extension based on early studies that evaluated isolated sectioning of the ligament [15,16]. More advanced biomechanical studies have recently shown the superficial MCL to provide the primary restraint to valgus force at all angles through the arc of motion at its proximal end [17•, 18•].…”

Section: Biomechanicsmentioning

confidence: 99%

“…The deep MCL acts as a secondary static stabilizer, providing resistance to valgus stress at all angles of flexion [10, 17•]. A secondary function of the MCL is resistance to anterior and posterior stress, supplementing the primary function of the cruciate ligaments [16,19]. In addition, the MCL provides static restraint for rotational stability.…”

Section: Biomechanicsmentioning

confidence: 99%

“…In addition, the MCL provides static restraint for rotational stability. The load seen by the superficial MCL is highest in external rotation [18•], therefore an increase in tibial external rotation is seen with isolated sectioning of the ligament, especially at 90°of flexion [16]. This is in contrast to the posterior oblique ligament where the load is highest in internal rotation at full extension [17•, 18•].…”

Section: Biomechanicsmentioning

confidence: 99%

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Surgical approach to the posteromedial corner: indications, technique, outcomes

Bauer

Stannard

2013

Curr Rev Musculoskelet Med

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Injuries to the medial side of the knee can occur in isolation or in conjunction with multiple other ligaments about the knee. In addition, medial knee injuries can involve isolated injury to the medial collateral ligament or include the posteromedial structures of the knee. Treatment strategies differ greatly depending on injury pattern. In order to select an appropriate treatment strategy, one must accurately diagnose the injury pattern based on clinical examination and the use of appropriate imaging studies. The fundamental basis for diagnosis of a medial sided knee injury stems from understanding the static and dynamic stabilizing structures that compose the medial side of the knee. It is our aim to define the anatomic roles of medial sided structures, their importance in protecting the biomechanical stability of the knee, as well as provide indications and our preferred procedures for surgical management of these complex injuries.

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All the menisco‐ligamentary structures of the medial plane play a significant role in controlling anterior tibial translation and tibial rotation of the knee. Cadaveric study of 29 knees with the Dyneelax® laximeter

Guegan,

Drouineau,

Common

et al. 2024

J. exp. orthop.

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PurposeThis study aimed to determine the respective roles of the anterior cruciate ligament (ACL) and the different components of the medial plane in the control of anterior tibial translation and internal and external tibial rotation.MethodsTwenty‐nine fresh lower limbs, disarticulated at the hip, were tested in the anatomy laboratory. The following structures were isolated: the ACL, the anteromedial retinaculum (AMR), the medial collateral ligament (superficial and deep MCL), the posterior medial capsule (PMC) and the posterior horn of the medial meniscus (PHMM). The lower limb was positioned at 30° of flexion on the Dyneelax® laximeter (0.1 mm and 0.1° accuracies) and underwent anterior loads up to 200 N and internal and external tibial rotations sectioned from front to back. and the knee was then retested. The results were presented as relative gains in translation and rotations for each structure. Student's t test and Wilcoxon tests were used.ResultsThe relative gains in translation for the ACL, AMR, superficial MCL, deep MCL, PMC and PHMM, respectively, were 42.9%, 6.7%, 7.4%, 6%, 7.5% and 11.6%. The relative gains in internal rotation for ACL, AMR, superficial MCL, deep MCL, PMC and PHMM, respectively, were 13%, 6.9%, 4.6%, 3.9%, 13% and 8%. The relative gains in external rotation for ACL, AMR, superficial MCL, deep MCL, PMC and medial meniscus, respectively, were 8.9%, 6%, 9.7%, 13.8%,11.2% and 8.5%. All the relative gains in translation, internal and external rotations were significant at each step of transection (p < 0.01).ConclusionsThe ligamentous structures of the medial plane constitute a functional unit in which each component has a specific passive contribution. This study highlights the importance of recognising the extent of the medial ligament tears and performing a medial side anatomic and individual reconstruction and a suture of a ramp lesion, in addition to an ACL surgery.

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Role of the Medial Structures in the intact and Anterior Cruciate Ligament-Deficient Knee

Cited by 159 publications

References 39 publications

Bilateral Medial Tibiofemoral Joint Stiffness in Full Extension and 20° of Knee Flexion

Bilateral Medial Tibiofemoral Joint Stiffness in Full Extension and 20° of Knee Flexion

Surgical approach to the posteromedial corner: indications, technique, outcomes

All the menisco‐ligamentary structures of the medial plane play a significant role in controlling anterior tibial translation and tibial rotation of the knee. Cadaveric study of 29 knees with the Dyneelax® laximeter

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