Surgeons are often faced with very limited data available to make informed decisions regarding the appropriate treatment of patients with posteromedial corner (PMC) injuries of the knee. This study compared the outcomes of surgical repair versus reconstruction in knee dislocation patients who have sustained injury to the PMC of the knee. Senior author treated 113 consecutive knee dislocations with 115 PMC injuries over 7 years. A total of 71 knee dislocation patients with 73 PMC tears qualified for the study and were followed for a mean of 43 months. Patients who had a PMC repair were assigned to treatment Group A. Group B included patients who had autograft reconstruction of the PMC. Patients who had an allograft PMC were assigned to Group C. A total of 25 patients had a repair, with 5 failures (20%), whereas 48 patients had reconstruction of the PMC with 2 failures (4%). There was a significant difference between the failure rate of PMC repairs and PMC reconstructions. Reconstruction of the PMC using a technique that reestablishes the critical triangle of the medial collateral ligament, the posterior oblique ligament, and the semitendinosus yielded better stability than repair in patients with a knee dislocation that included PMC instability.
The objective of this study is to compare the cyclic loading strength and ultimate failure load in suture anchor repair versus transosseous tunnel repair of patellar tendons using a cadaver model. Twelve cadaveric patella specimens were used (six matched pairs). Dual-energy X-ray absorptiometry (DXA) measurements were performed to ensure equal bone quality among groups. All right knees were assigned to the suture anchor repair group ( = 6), whereas all left knees were assigned to the transosseous bone tunnel group ( = 6). Suture type and repair configuration were equivalent. After the respective procedures were performed, each patella was mounted into a gripping jig. Tensile load was applied at a rate of 1 Hz between magnitudes of 50 and 150 N, 50 and 200 N, 50 and 250 N, and tensile load at a rate of 0.1 mm/s until failure. Failure was defined as a sharp deviation in the linear load versus displacement curve, and failure mode was recorded. DXA measurements demonstrated equivalence of bone quality between the two groups ( > 0.05). During cyclic load testing, there was only a statistically significant difference between the groups with regard to cyclic loading at the 50 to 200 N loading cycle ( = 0.010). There was no statistically significant difference between the groups with regard to ultimate load to failure ( = 0.43). Failure mode within the suture anchor cohort occurred through anchor pullout except for one, which failed through the tendon. All specimens within the transosseous cohort failed through the midsubstance of the tendon except for one, which failed through suture breakage. Suture anchor repair demonstrated a similar biomechanical profile regarding cyclic loading and ultimate load to failure when compared with "gold standard" transosseous tunnel patellar tendon repair with a trend toward less gapping in the suture anchor group. Using suture anchors for repair of the patella tendon has similar biomechanical properties to transpatellar tunnels but may provide other clinical advantages.
Acute posterolateral corner injuries of the knee are rare and, when present, are frequently associated with concurrent ligament injury, neurovascular damage, or fractures of the femur or tibia. Early surgical treatment has been shown to be superior to delayed and nonoperative treatment of multiligamentous knee injuries. Historically, repair has been advocated. High-quality studies comparing repair versus reconstruction have shown that reconstruction yields superior results with respect to failure of the construct and similar outcomes with respect to patient satisfaction. Our preferred technique for reconstruction of the acute posterolateral corner with reinforcement is described.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.