A “Short Isometric Construct” Reconstruction Technique for the Medial Collateral Ligament of the Knee

Borque, Kyle A.; Ball, Simon; Sij, Ethan; Amis, Andrew A.; Laughlin, Mitzi S.; Jones, Mary; Williams, Andy

doi:10.1016/j.eats.2022.10.005

Cited by 5 publications

(12 citation statements)

References 20 publications

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“…Rather than restore native kinematics, it needs only to protect the soft tissue repairs while allowing the knee to undergo early range of motion until healing is complete. Therefore, it is more important that the reconstruction is biomechanically effective rather than necessarily anatomic [3, 8]. The strong constructs created by combining repair and reconstruction also allow for safe, early range of motion, decreasing stiffness and improving proprioception.…”

Section: Discussionmentioning

confidence: 99%

“…The approach for collateral ligament injuries consisted of a combination of repair and reconstruction to protect the repair and allow early motion (Fig. 2) [3, 5, 8, 16, 32, 42].…”

Section: Methodsmentioning

confidence: 99%

“…Prior studies have shown reconstruction to be superior to repair in MLKIs in restoring mechanical stability [34, 36, 50] , but isolated reconstruction does not address the significant proprioceptive deficit which frequently hinders athletes’ ability to return to sport [25, 33, 44]. Advances in the understanding of medial and lateral soft tissue knee anatomy have led to improved anatomic repair techniques [29, 45, 51, 53], which provide the potential to minimize the proprioceptive deficit [8, 38, 40, 52]. In an effort to maximize the benefit of both approaches, a combination of repair and reconstruction was utilized for all collateral injuries, an approach which has never been evaluated in the literature.…”

Section: Introductionmentioning

confidence: 99%

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High return to play rate following treatment of multiple-ligament knee injuries in 136 elite athletes

Borque

Jones

Balendra

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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PurposeThe purpose of the study is to assess return to play rate and timing of elite athletes treated for multi-ligament knee injuries with modern surgical techniques. Methods A retrospective review was performed of all professional or national/international level athletes treated for a multiligament knee injury by the senior author in the period from February 2001 to October 2019, with a minimum of 2-year follow-up. The study cohort consisted of 136 elite athletes who underwent surgery of two or more knee ligaments. Outcomes measures were return to play (RTP), deined as return to elite level sport, return to play time, and further surgical procedures. Results One hundred and twenty (88.2%) athletes returned to elite level sport at an average of 12.8 months from operation. In unicruciate injuries, ACL and PCL-based injuries had similar return to play rates (89.1% vs. 87.5% respectfully, n.s.) although mean RTP time was longer in those with PCL-based injuries (15.2 vs. 11.9 months, p < 0.01). Bicruciate injuries had longer RTP times compared to unicruciate injuries (mean RTP 16.0vs. 12.4 months, p < 0.05) but were able to return at a similar rate (83.3% vs. 88.9%, n.s.). Medial and lateral sided injuries had similar RTP rates (89.3% vs. 87.9%, n.s.) though lateral sided injuries took longer before returning to play (13.4 vs. 11.6 months, p < 0.05). Further surgery was required in 54 (39.9%) patients including 25 (18.4%) manipulations under anaesthesia. Four (2.9%) of the athletes underwent revision ligament surgery. Conclusion Modern surgical techniques used in the treatment of multi-ligament knee injuries can lead to high return to play rates in elite athletes. Level of evidence IV.

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Section: Discussionmentioning

confidence: 99%

“…The approach for collateral ligament injuries consisted of a combination of repair and reconstruction to protect the repair and allow early motion (Fig. 2) [3, 5, 8, 16, 32, 42].…”

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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High return to play rate following treatment of multiple-ligament knee injuries in 136 elite athletes

Borque

Jones

Balendra

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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“…5,26 While these constructs represent significant advances in the treatment of medial-sided knee injuries, the authors of this study wished to assess whether the same results could be accomplished using a single-strand construct in an effort to decrease the costs, the chances of tunnel convergence, and the complexity of surgical technique. 6,11 The decision was made to focus on the most common injury pattern noted in the clinical setting: an injury to the dMCL and sMCL with the POL remaining intact. 43 Initially, 2 constructs were identified that had a high potential of accomplishing our objective.…”

Section: -In-5mentioning

confidence: 99%

“…To ensure isometric placement of the reconstruction, two 1.6-mm K-wires were placed: one at the center of the medial epicondyle on the femur 2,33,43 and the other at a point 20 mm below the tibial articular margin at the halfway point between the anterior and posterior margins of the sMCL. 6 The isometry of the construct was assessed with a suture passed around both K-wires while the knee was taken through a full range of motion while maintaining a ''neutral'' axial rotation. If the construct was anisometric, the K-wires were moved and isometry was retested until confirmed.…”

Section: Surgical Proceduresmentioning

confidence: 99%

Single-Strand “Short Isometric Construct” Medial Collateral Ligament Reconstruction Restores Valgus and Rotational Stability While Isolated Deep MCL and Superficial MCL Reconstruction Do Not

Borque,

Han,

Dunbar

et al. 2024

Am J Sports Med

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Background: Historical MCL (medial collateral ligament) reconstruction (MCLR) techniques have focused on the superficial MCL (sMCL) to restore valgus stability while frequently ignoring the importance of the deep MCL (dMCL) in controlling tibial external rotation. The recent recognition of the medial ligament complex importance has multiple studies revisiting medial anatomy and questioning contemporary MCLR techniques. Purpose: To assess whether (1) an isolated sMCL reconstruction (sMCLR), (2) an isolated dMCL reconstruction (dMCLR), or (3) a novel single-strand short isometric construct (SIC) would restore translational and rotational stability to a knee with a dMCL and sMCL injury. Study Design: Controlled laboratory study. Methods: Biomechanical testing was performed on 14 fresh-frozen cadaveric knee specimens using a custom multiaxial knee activity simulator. The specimens were divided into 2 groups. The first group was tested in 4 states: intact, after sectioning the sMCL and dMCL, isolated sMCLR, and isolated dMCLR. The second group was tested in 3 states: intact, after sectioning the sMCL and dMCL, and after single-strand SIC reconstruction (SICR). In each state, 4 loading conditions were applied at 0°, 20°, 40°, 60°, and 90° of knee flexion: 8-N·m valgus torque, 5-N·m external rotation torque, 90-N anterior drawer, and combined 90-N anterior drawer plus 5-N·m tibial external rotation torque. Anterior translation, valgus rotation, and external rotation of the knee were measured for each state and loading condition using an optical motion capture system. Results: sMCL and dMCL transection resulted in increased laxity for all loading conditions at all flexion angles. Isolated dMCLR restored external rotation stability to intact levels throughout all degrees of flexion, yet valgus stability was restored only at 0° of flexion. Isolated sMCLR restored valgus and external rotation stability at 0°, 20°, and 40° of flexion but not at 60° or 90° of flexion. Single-strand SICR restored valgus and external rotation stability at all flexion angles. In the combined anterior drawer plus external rotation test, isolated dMCL and single-strand SICR restored stability to the intact level at all flexion angles, while the isolated sMCL restored stability at 20° and 40° of flexion but not at 60° or 90° of flexion. Conclusion: In the cadaveric model, single-strand SICR restored valgus and rotational stability throughout the range of motion. dMCLR restored rotational stability to the knee throughout the range of motion but did not restore valgus stability. Isolated sMCLR restored external rotation and valgus stability in early flexion. Clinical Relevance: In patients with anteromedial rotatory instability in the knee, neither an sMCLR nor a dMCLR is sufficient to restore stability.

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Ligament augmentation and reconstruction system (LARS) synthetic grafts are safe and effective for medial collateral ligament and posterolateral corner reconstructions in elite athletes

Jones,

Pinheiro,

Church

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeThis study documents the efficacy and safety of using a Ligament Augmentation and Reconstruction System (LARS) ligament graft to augment extra‐articular knee ligament reconstructions in elite athletes by reporting return‐to‐play (RTP) rates and levels, career longevity and complications.MethodsA consecutive series of all extra‐articular knee ligament reconstructions augmented by LARS ligaments in elite athletes undertaken by three specialist sports knee surgeons between 2013 and 2020 were reviewed. Seventy‐six elite athletes, aged over 16 years old, and more than 2 years postsurgery were included. RTP was defined as competing at professional level or national/international level in amateur sport.ResultsThere were 64 medial collateral ligament (MCL) and 12 posterolateral corner (PLC) reconstructions. Fifty‐two (68.4%) underwent concomitant autograft cruciate ligament(s) reconstruction. The mean age was 25.1 years (SD ± 4.5). Most were football (35, 46.1%) or rugby players (35, 46.1%). Sixty‐seven athletes (88.2%) RTP with 65 (97.0%) of these playing at the same or higher Tegner level. Fifty‐six (83.6%) of the athletes that RTP were still playing at 2 years postsurgery. Twenty (57.1%) of those who had RTP and were more than 5 years postsurgery were still playing at 5 years. Six (7.9%) players required further surgery relating to the LARS/metalwork. One case had soft tissue inflammation adjacent to the proximal end of the synthetic graft, but it is unknown if this was mechanical irritation or a biological reaction. One MCL reruptured 4 years after RTP.ConclusionUtilising LARS to augment extra‐articular knee ligament reconstructions allows 88.2% of athletes with a variety of knee ligament injuries to return to elite sport. The low morbidity rates coupled with 57% of athletes still playing 5 years postsurgery demonstrates that the LARS is safe and effective in these cases. Although there are reports of LARS ligaments being used in MCL and PLC reconstructions, there is very little evidence investigating if they are safe and effective. This study demonstrates that LARS synthetic grafts can be safely used for MCL and PLC reconstructions in elite athletes and they permit a high RTP with a low risk of complications.Level of EvidenceLevel IV.

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A “Short Isometric Construct” Reconstruction Technique for the Medial Collateral Ligament of the Knee

Cited by 5 publications

References 20 publications

High return to play rate following treatment of multiple-ligament knee injuries in 136 elite athletes

High return to play rate following treatment of multiple-ligament knee injuries in 136 elite athletes

Single-Strand “Short Isometric Construct” Medial Collateral Ligament Reconstruction Restores Valgus and Rotational Stability While Isolated Deep MCL and Superficial MCL Reconstruction Do Not

Ligament augmentation and reconstruction system (LARS) synthetic grafts are safe and effective for medial collateral ligament and posterolateral corner reconstructions in elite athletes

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