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

Bauer, Kathryn; Stannard, James P.

doi:10.1007/s12178-013-9161-3

Cited by 28 publications

(15 citation statements)

References 47 publications

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“…In AMRI, there is an abnormal excess opening of the medial joint space in abduction at 30° of knee flexion, with a simultaneous anteromedial rotatory subluxation of the medial tibial condyle on the central axis of the intact posterior cruciate ligament. This subtle additional rotatory instability differentiates it from isolated open-book instability seen with isolated medial collateral ligament injury (1,12,29,30). Deficiency of the PMC can lead to persistent valgus instability and failure of ACL and PCL reconstructions (14,23).…”

Section: Pmc Injuriesmentioning

confidence: 99%

“…When PMC and MCL injuries are both present, stronger consideration of the patient for surgery may be warranted (1,7,14). Symptomatic, functional AMRI in patients with isolated or concurrent ACL and PMC injuries is an indication for surgical treatment of the PMC (7,29). When both the PCL and PMC are injured, surgical repair of both ligaments is indicated (14).…”

Section: Treatment Of Pmc Injuriesmentioning

confidence: 99%

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Posteromedial Corner of the Knee: The Neglected Corner

Lundquist¹,

Matcuk²,

Schein³

et al. 2015

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The posteromedial corner of the knee (PMC) is an important anatomic structure that is easily seen but often overlooked on magnetic resonance (MR) images. Whereas the posterolateral corner has been referred to as the "dark side of the knee" by some authors owing to widespread lack of knowledge of its complex anatomy, even less is written about the PMC; yet it is as important as the posterolateral corner in multiligament injuries of the knee. The PMC lies between the posterior margin of the longitudinal fibers of the superficial medial collateral ligament (MCL) and the medial border of the posterior cruciate ligament (PCL). The anatomy of the PMC can be complex and the literature describing it can be confusing, at times oversimplifying it and at other times adding unnecessary complexity. Its most important structures, however, can be described more simply as five major components, and can be better shown with illustrations that emphasize the anatomic distinctions. Injuries to the PMC are important to recognize, as disruption of the supporting structures can cause anteromedial rotational instability (AMRI). Isolated PMC injuries are rare; most occur in conjunction with injuries to other important stabilizing knee structures such as the anterior cruciate ligament (ACL) and PCL. Unrecognized and unaddressed injury of the PMC is one of the causes of ACL and PCL graft failures. Recognition of PMC injuries is critical, as the diagnosis will often change or require surgical management.

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Section: Pmc Injuriesmentioning

confidence: 99%

Section: Treatment Of Pmc Injuriesmentioning

confidence: 99%

Posteromedial Corner of the Knee: The Neglected Corner

Lundquist¹,

Matcuk²,

Schein³

et al. 2015

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“…The release is usually carried on after resecting the osteophyte, and gradually carried on until the medial collateral ligament is well balanced [19].…”

Section: Discussionmentioning

confidence: 99%

Posteromedial Corner Release with the Knee in Figure-of-Four Position vs Conventional Position for Varus Knee Arthroplasty

Zheng

et al. 2020

Preprint

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Backgroud: The objective of this study is to introduce posteromedial corner release with the knee in the figure-of-four position versus the conventional position for varus knee arthroplasty. Methods : From March 2015 to September 2019, 123 patients (139 knees) with varus knee were randomly and blindly allocated to experimental group (60 patients; 68 knees) and control group (57 patients; 65 knees). Patients in experimental group underwent posteromedial corner release with the knee in the figure-of-four position; and patients in control group with the knee in the conventional position. Time for soft tissue balancing was defined as the time from the start of spacer test to the end of balance test. Length of release was defined as the distance from the osteotomy surface of the tibial plateau to the farthest structures released. The rating system of Hospital for Special Surgery (HSS) knee score was used to evaluate the clinical results. Differences were considered statistically significant at p < 0.05. Results: The mean time for soft tissue balancing was 8.4±3.3 minutes and 8.4±3.3 minutes in experimental and control group, respectively ( p <0.05). The mean length of releasing posteromedial corner structures was 35.5±13.4 mm and 27.3±9.7 mm in experimental and control group, respectively ( p <0.05). HSS scores 5 years after surgery were 95.1±16.9 and 94.8±17.2 respectively ( p >0.05). Conclusion: During varus knee arthroplasty, the posteromedial corner can be released more extensively and thoroughly when the knee is placed in the figure-of-four position.

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“…The results of this technique have been very favorable, particularly in the setting of a knee dislocation where tunnel crowding is avoided with only a single femoral socket and a single tibial screw. 3,14,19,21,22 CONCLUSIONS Our understanding of the medial side of the knee has improved remarkably over the past decade or so. The anatomy as it relates to both function and surgical reconstruction has been carefully evaluated.…”

Section: Operative Treatmentmentioning

confidence: 99%

“…[4][5][6][7][8][9][10][11][12][13] There have also been many review articles published in the past decade that summarize many aspects of medial side treatments. [14][15][16][17][18][19][20][21][22][23][24] Many of these publications are recognizing the differences between a torn medial collateral ligament (MCL) and a torn posteromedial corner (PMC). An increased understanding of knee anatomy and biomechanics has led to the design of a number of reconstructions that increasingly attempt to replicate the normal PMC.…”

mentioning

confidence: 99%

Evaluation and Treatment of Medial Instability of the Knee

Stannard¹

2015

Sports Medicine and Arthroscopy Review

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Medial knee ligament injury and instability has frequently been treated by bracing and physical therapy. That has worked well in many instances and patients have been able to resume preinjury activities. However, there is a subset of patients that remain unstable when treated with conservative measures. A critical question we face is why these knees fail when the majority heal well and regain function? What are the differences that lead to failure and how can surgeons recognize these differences and determine which patients will benefit from primary surgical repair or reconstruction?

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

Cited by 28 publications

References 47 publications

Posteromedial Corner of the Knee: The Neglected Corner

Posteromedial Corner of the Knee: The Neglected Corner

Posteromedial Corner Release with the Knee in Figure-of-Four Position vs Conventional Position for Varus Knee Arthroplasty

Evaluation and Treatment of Medial Instability of the Knee

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