Treatment of Medial Collateral Ligament Injuries

Miyamoto, Ryan G.; Bosco, Joseph; Sherman, Orrin H.

doi:10.5435/00124635-200903000-00004

Cited by 108 publications

(92 citation statements)

References 45 publications

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“…Because these injuries are so common, it has not been unusual in the senior partner's (RFL) practice to have patients referred to him with chronic isolated posterolateral corner injuries who were in fact misdiagnosed with medial knee injuries and who had major functional limitations, especially with side-to-side instability. Thus, we established a collaborative project with the University of Oslo to develop an anatomic medial knee reconstruction technique to better restore the static function and overall stability to these patients and to allow immediate postoperative knee motion to decrease the risk of the postoperative stiffness issues commonly seen with medial knee surgeries [11]. This involved detailed quantitative anatomic studies [9], static biomechanical sectioning studies [5], assessment of forces in the native medial knee structures to applied loads [4,15], and the development and biomechanical validation of an anatomic medial knee reconstruction technique [3].…”

Section: Introductionmentioning

confidence: 99%

Surgical Technique: Development of an Anatomic Medial Knee Reconstruction

LaPrade

Wijdicks

2012

Clinical Orthopaedics &Amp; Related Research

180

222

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Background The main static stabilizers of the medial knee are the superficial medial collateral and posterior oblique ligaments. A number of reconstructive techniques have been advocated including one we describe here. However, whether these reconstructions restore function and stability is unclear. Description of Technique This anatomic reconstruction technique consisted of reconstruction of the proximal and distal divisions of the superficial medial collateral and the posterior oblique ligament using two separate grafts. Patients and Methods We prospectively followed all 28 patients (19 male, nine females) who had this new reconstruction between 2007 and 2009. The average age was 32.4 years (range, 16-56 years). There were eight acute and 20 chronic injuries. All patients presented with side-to-side instability with activities of daily living and other higher level activities. Minimum followup was 6 months (average, 1.5 years; range, 0.5-3 years). No patients were lost to followup. Results Preoperative International Knee Documentation Committee subjective outcome scores averaged 43.5 (range, 14-66) and final postoperative values averaged 76.2 (range, 54-88). Preoperative valgus stress radiographs averaged 6.2 mm of medial compartment gapping compared with the contralateral normal knee, whereas postoperative stress radiographs averaged 1.3 mm. Conclusions Early observations suggest this anatomic reconstruction technique improves overall patient function and restores valgus instability.

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Section: Introductionmentioning

confidence: 99%

Surgical Technique: Development of an Anatomic Medial Knee Reconstruction

LaPrade

Wijdicks

2012

Clinical Orthopaedics &Amp; Related Research

180

222

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“…Most MCL lesions heal with nonoperative treatment and chronic MCL instability is rare [18], but up to 78% of Grade III MCL injuries are associated with an ACL lesion [2]. Injuries to the posterior oblique ligament (POL) are associated with Grade III medial injuries [19] with resulting valgus and rotatory instability [4].…”

Section: Introductionmentioning

confidence: 99%

Surgical Technique: Does Mini-invasive Medial Collateral Ligament and Posterior Oblique Ligament Repair Restore Knee Stability in Combined Chronic Medial and ACL Injuries?

Canata

Chiey

Leoni

2012

Clinical Orthopaedics &Amp; Related Research

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Background Residual laxity remains after ACL reconstruction in patients with combined chronic ACL and medial instability. The question arises whether to correct medial capsular and ligament injuries when Grade II and III medial laxity is present. Description of Technique We developed a mini-invasive medial ligament plasty to repair the medial collateral ligament to correct residual medial valgus and rotatory laxity after ACL reconstruction. Patients and Methods We prospectively followed 36 patients with an ACL deficiency combined with chronic Grade II or III valgus and rotatory medial instability. The mean age was 37 years (range, 15-70 years).

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“…For most acute soft-tissue knee injuries, complete immobilization is not required; if immobilization is used to alleviate pain and swelling, it should be of limited duration. [11][12][13][14][15][16] Patellar dislocation is arguably an exception, as is the grossly unstable knee. 1,[17][18][19][20] Management of these patients is undertaken in different clinical environments by various health care providers.…”

Section: Discussionmentioning

confidence: 99%

“…[33][34][35][36][37][38] Despite the need to consider each subcategory of injury as a unique entity, current evidence suggests that for most acute soft-tissue knee injuries (except grossly unstable knee injuries and patellar dislocations), complete immobilization is not required and its use should be limited. [11][12][13][14][15][16] Some authors suggest hinged knee braces be used to splint knees that are unstable in the coronal plane to provide protection to the healing tissues while allowing motion. 3,7,[9][10][11] In light of our results, there is a need for clarification and distribution of current recommendations.…”

Section: Discussionmentioning

confidence: 99%

The use of early immobilization in the management of acute soft-tissue injuries of the knee: results of a survey of emergency physicians, sports medicine physicians and orthopedic surgeons

Sommerfeldt

Bouliane

Otto

et al. 2015

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Background: Evidence-based guidelines on the use of immobilization in the management of common acute soft-tissue knee injuries do not exist. Our objective was to explore the practice patterns of emergency physicians (EPs), sports medicine physicians (SMPs) and orthopedic surgeons (OS) regarding the use of early immobilization in the management of these injuries. Methods:We developed a web-based survey and sent it to all EPs, SMPs and OS in a Canadian urban centre. The survey was designed to assess the likelihood of prescribing immobilization and to evaluate factors associated with physicians from these 3 disciplines making this decision. Results:The overall response rate was 44 of 112 (39%): 17 of 58 (29%) EPs, 7 of 15 (47%) SMPs and 20 of 39 (51%) OS. In cases of suspected meniscus injuries, 9 (50%) EPs indicated they would prescribe immobilization, whereas no SMPs and 1 (5%) OS would immobilize (p = 0.002). For suspected anterior cruciate ligament injuries, 13 (77%) EPs, 2 (29%) SMPs and 5 (25%) OS said they would immobilize (p = 0.005). For lateral collateral ligament injuries, 9 (53%) EPs, no SMPs and 6 (32%) OS would immobilize (p = 0.04). All respondents would prescribe immobilization for a grossly unstable knee. Conclusion:We found that EPs were are more likely to prescribe immobilization for certain acute soft-tissue knee injuries than SMPs and OS. The development of an evidenced-based guideline for the use of knee immobilization after acute soft-tissue injury may reduce practice variability.Contexte : Il n'existe pas de lignes directrices factuelles sur le recours à l'immo bilisation pour la prise en charge des traumatismes aigus communs qui affectent les tissus mous du genou. Notre objectif était d'explorer les habitudes de pratique des urgentologues, des médecins du sport et des chirurgiens orthopédistes quant au recours à l'immobilisation pour la prise en charge initiale de ces blessures.Méthodes : Nous avons conçu un sondage Web et l'avons fait parvenir à tous les urgentologues, médecins du sport et chirurgiens orthopédistes d'un centre urbain canadien. Le sondage visait à évaluer la probabilité que l'immobilisation soit prescrite et à dégager les facteurs associés à ce type de décision chez les praticiens de ces 3 disciplines.

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Treatment of Medial Collateral Ligament Injuries

Cited by 108 publications

References 45 publications

Surgical Technique: Development of an Anatomic Medial Knee Reconstruction

Surgical Technique: Development of an Anatomic Medial Knee Reconstruction

Surgical Technique: Does Mini-invasive Medial Collateral Ligament and Posterior Oblique Ligament Repair Restore Knee Stability in Combined Chronic Medial and ACL Injuries?

The use of early immobilization in the management of acute soft-tissue injuries of the knee: results of a survey of emergency physicians, sports medicine physicians and orthopedic surgeons

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