Superficial Medial Collateral Ligament Reattachment During High Tibial Osteotomy: Regulate Tension, Preserve Stability!

Malinowski, Konrad; Sibilska, Aleksandra; Góralczyk, Adrian; LaPrade, Robert F.; Hermanowicz, Krzysztof

doi:10.1016/j.eats.2019.07.002

Cited by 4 publications

(6 citation statements)

References 14 publications

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“…36 The American Journal of Sports Medicine 2022;50 (1):142-151 DOI: 10.1177/03635465211059162 Ó 2021 The Author(s) Some have even argued that the sMCL should be fixed after release. 30 Conversely, valgus laxity has not been cited as a common complication of HTO from a clinical perspective. 41 However, evidence supporting the safety of transection of the sMCL is still scarce and debatable.…”

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confidence: 99%

Does Transection of the Superficial MCL During HTO Result in Progressive Valgus Instability?

et al. 2021

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Background: During high tibial osteotomy (HTO), the superficial medial collateral ligament (sMCL) is cut or released at any degree to expose the osteotomy site and achieve the targeted alignment correction according to the surgeon’s preference. However, it is still unclear whether transection of sMCL increases valgus laxity. Purpose: We aimed to assess the outcomes and safety of sMCL transection, especially focusing on iatrogenic valgus instability. Study Design: Case series; Level of evidence, 4. Methods: Seventy-two patients (89 knees) who underwent medial open wedge HTO (MOWHTO) with transection of the sMCL between October 2013 and September 2018 were retrospectively investigated. Clinical evaluations, including the International Knee Documentation Committee (IKDC) score, Knee injury and Osteoarthritis Outcome Score (KOOS), and Tegner and Lysholm scores, were performed preoperatively and at 2 years postoperatively. The radiographic parameters hip-knee-ankle (HKA) angle, joint line convergence angle on standing radiographs (standing JLCA), and weightbearing line (WBL) ratio were assessed preoperatively and at 3 months, 6 months, 1 year, and 2 years postoperatively. To evaluate valgus laxity, we assessed the valgus JLCA and medial joint opening (MJO) at the aforementioned time points using valgus stress radiographs. Results: All clinical results at the 2-year follow-up were significantly improved compared with those obtained at the preoperative assessment ( P < .001). The postoperative HKA angle significantly differed from the preoperative one, and no significant valgus progression was observed during follow-up (preoperative, 8.5°± 2.7°; 3 months, –3.5°± 2.0°; 6 months, –3.2°± 2.3°; 1 year, –3.1°± 2.3°; 2 years, –2.9°± 2.5°; P < .001) The mean WBL ratio was 62.5% ± 9.0% at 2 years postoperatively. The postoperative valgus JLCA at all follow-up points did not significantly change compared with the preoperative valgus JLCA (preoperative, –0.1°± 2.1°; 3 months, –0.2°± 2.4°; 6 months, –0.1°± 2.5°; 1 year, 0.1°± 2.5°; 2 years, 0.2°± 2.2°) The postoperative MJO at all follow-up points did not significantly change compared with the preoperative MJO (preoperative, 7.1 ± 1.7 mm; 3 months, 7.0 ± 1.7 mm; 6 months, 6.9 ± 1.9 mm; 1 year, 6.7 ± 1.8 mm; 2 years, 6.8 ± 1.8 mm). Conclusion: Transection of the sMCL during MOWHTO does not increase valgus laxity and could yield desirable clinical and radiographic results.

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confidence: 99%

Does Transection of the Superficial MCL During HTO Result in Progressive Valgus Instability?

et al. 2021

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“…Some authors reported that sMCL should be kept to a minimum or fixed after manipulation to preserve stability [11][12][13]. Pape et al [13] reported an increased medial joint opening after release of the sMCL and possible late valgus instability.…”

Section: Discussionmentioning

confidence: 99%

“…While both techniques are widely performed by surgeons during MOWHTO, concerns have been raised about valgus laxity following sMCL release based on previous biomechanical studies and attempts to restore the sMCL after the release are being made [11][12][13][14]. However, some authors have reported that neither release nor transection increases valgus instability [7,15].…”

Section: Introductionmentioning

confidence: 99%

Release or transection of superficial medial collateral ligament during open‐wedge high tibial osteotomy demonstrated similar clinical outcomes and valgus laxity

Jung,

Choi,

Kim

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeTo analyse whether valgus laxity and clinical outcomes differ depending on whether the superficial medial collateral ligament (sMCL) is released or transected during medial open‐wedge high tibial osteotomy (MOWHTO).MethodsConsecutive patients who underwent MOWHTO and subsequent radiological follow‐up for at least 2 years were retrospectively evaluated. The patients were divided into release and transection groups, according to the sMCL manipulation technique. Each patient was assessed for the following variables on valgus stress radiographs taken before surgery and at the 12‐ and 24‐month follow‐ups: the absolute value of valgus (ABV) and side‐to‐side difference (SSD) between the affected and normal sides. The differences between preoperative SSD and those at 12 and 24 months were respectively calculated and defined as delta SSD (ΔSSD). The Visual Analogue Scale, Lysholm knee, International Knee Documentation Committee subjective, and Knee Injury and Osteoarthritis Outcome scores were used to evaluate patient‐reported outcomes.ResultsEighty‐five patients were included in the study. Forty‐two patients (49.6%) underwent sMCL release, and the remaining 43 patients (50.4%) underwent sMCL transection. No significant differences were observed in the ABV and SSD of valgus laxity at the different time points between the two groups (n.s.). Furthermore, no significant differences were observed in the ΔSSD at the 12‐ and 24‐month follow‐ups between the two groups (n.s.). Significant improvement from preoperative values was observed in all patient‐reported outcomes (p < 0.001), with no significant differences between the two groups at any time point (n.s.).ConclusionSignificant improvements in clinical outcomes were observed, regardless of the technique used. Postoperative valgus laxity did not occur with either technique. The transection technique, which can be performed more simply and quickly, demonstrated similar clinical outcomes and valgus laxity to the release technique.Level of EvidenceLevel III.

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“…5 There has been much discussion about the management of the medial collateral ligament (MCL) following OW-HTO. 6,7 It is well-known that the MCL has to be released in OW-HTO. 6 In a standard approach for OW-HTO, the MCL is raised subperiosteally to the posteromedial tibia before a large retractor is placed behind the tibia to protect the neurovascular structures (NVS).…”

mentioning

confidence: 99%

“…6,7 It is well-known that the MCL has to be released in OW-HTO. 6 In a standard approach for OW-HTO, the MCL is raised subperiosteally to the posteromedial tibia before a large retractor is placed behind the tibia to protect the neurovascular structures (NVS). However, the surgical assistant often has to fight against the resistance of the intact MCL, and this poses challenges in visualization and instrument placement in the surgical field.…”

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confidence: 99%

Soft-Tissue Management and Neurovascular Protection During Opening-Wedge High Tibial Osteotomy

Kley

Razak

Khakha

et al. 2021

Arthroscopy Techniques

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Medial opening-wedge high tibial osteotomy (OW-HTO) is an excellent surgical option for patients with varus knee osteoarthritis. Medial collateral ligament (MCL) release and posterior neurovascular structure protection during OW-HTO are steps that often induce stress and nervousness during surgery, especially for surgeons in the earlier stages of their learning curve. While is it well-known that the MCL should be released during OW-HTO, the standard retraction techniques pose challenges in visualization and instrument placement in the surgical field. We present our technique, which illustrates an alternative method to manage the MCL and safely protect the neurovascular structures using a second and more posterior surgical window during OW-HTO.

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Superficial Medial Collateral Ligament Reattachment During High Tibial Osteotomy: Regulate Tension, Preserve Stability!

Cited by 4 publications

References 14 publications

Does Transection of the Superficial MCL During HTO Result in Progressive Valgus Instability?

Does Transection of the Superficial MCL During HTO Result in Progressive Valgus Instability?

Release or transection of superficial medial collateral ligament during open‐wedge high tibial osteotomy demonstrated similar clinical outcomes and valgus laxity

Soft-Tissue Management and Neurovascular Protection During Opening-Wedge High Tibial Osteotomy

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