Should the Ipsilateral Hamstrings Be Used for Anterior Cruciate Ligament Reconstruction in the Case of Medial Collateral Ligament Insufficiency? Biomechanical Investigation Regarding Dynamic Stabilization of the Medial Compartment by the Hamstring Muscles

Abstract

In the valgus-unstable knee, these data suggest that the hamstring muscles should be preserved in (multi-) ligament surgery when possible.

Graft Choice for Anterior Cruciate Ligament Reconstruction With a Concomitant Non-surgically Treated Medial Collateral Ligament Injury Does Not Influence the Risk of Revision

“…The late ACL reconstruction in a majority of the patients likely means that most MCL injuries were at least partially healed when the ACL reconstruction was performed. Although this does not exclude the possibility of valgus laxity still being present, it should probably be distinguished from the state of a complete MCL injury, which Herbort et al 11 tested biomechanically and reported that the medial hamstrings were crucial for valgus stability in this setting. In contrast, Kremen et al 12 cut only the superficial MCL to mimic a partial MCL injury and reported that an ACL reconstruction in this setting was still not sufficient to restore valgus rotational stability in the absence of ST and The proportion of patients with exact 95% confidence intervals achieving the 1-year patient acceptable symptom state in the Knee Injury and Osteoarthritis Outcome Score subscales for each study group respectively.…”

“…The rationale for this study was based on findings in cadaveric studies suggesting that harvesting the medial hamstrings in the MCL-injured knee would result in an inferior outcome due to a further compromised ability to resist valgus forces. 11,12 Although a registry study per se cannot provide causality and that specific characteristics such as location and severity of the MCL injuries are not included in the SNKLR, this study adds clinical data regarding graft choice for ACL reconstruction with a concomitant MCL injury. However, the long time from injury to surgery (mean 314 days) in this study should be considered when interpreting the results.…”

“…[7][8][9][10] Recent biomechanical studies have shown that the medial hamstrings are important to resist valgus forces in the MCL-deficient knee. 11,12 This becomes especially relevant when considering that a hamstring tendon (HT) autograft is one of the most frequently used graft choices for ACL reconstruction worldwide 13,14 and questions whether an alternative graft should be selected when performing ACL reconstruction in the MCL-injured knee not to further compromise medial side laxity and ACL graft survival.…”

“…A study of human cadaver knees revealed that the activation of the ST and gracilis after complete MCL sectioning restored valgus angles close to those observed for an intact MCL when a knee valgus moment was applied. 11 Another cadaveric study evaluated valgus stability after ACL reconstruction with a concomitant superficial MCL tear and found that rotational valgus stability was only restored when the ST and gracilis muscles were activated. 12 From cadaveric studies, it therefore appears plausible that HT harvest for ACL reconstruction in the MCL-deficient knee may further compromise valgus laxity, which may increase the forces on the newly reconstructed ACL.…”

Update vordere Kreuzbandruptur

“…Wichtige Nachteile einer konventionellen VKB-Plastik sind weiterhin die Notwendigkeit der Entnahme einer autologen Sehne mit dementsprechend verbundener Entnahmemorbidität, Schwä-chung von Muskulatur (Semitendinosus -Agonist des VKB und des medialen Kollateralbandes [MCL]) [12], der aktiven medialen Stabilisatoren und Defiziten in der Propriozeption bei Verlust der nervalen und propriozeptiven Potenz des ursprünglichen Kreuzbandgewebes. Weiterhin besteht eine erhöhte Gefahr der Rezidivinstabilität bei ungenauer Platzierung der Bohrkanäle.…”