Anatomical Reconstruction of the Medial Collateral Ligament and Posteromedial Corner of the Knee in Patients With Chronic Medial Collateral Ligament Instability

Lind, Martin; Jakobsen, Bent Wulff; Lund, Bent; Hansen, Mette Lausten; Abdallah, Ossama; Christiansen, Sofus

doi:10.1177/0363546509332498

Cited by 240 publications

(266 citation statements)

References 23 publications

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“…We observed no limitation in the ROM in our patients with proximal repair, while, in MCL reconstructions, Lind et al [13] found ROM deficits in 20% of patients. The mini-invasive technique, associated with BPTB ACL reconstruction, restored the medial laxity not addressed by an isolated ACL reconstruction [32] and preserved the active medial restraints, which surgeons frequently use in reconstructive techniques.…”

Section: Discussioncontrasting

confidence: 46%

“…The medial collateral ligament (MCL) is the most frequently injured ligament in the knee [13]. 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].…”

Section: Introductionmentioning

confidence: 99%

“…Lind et al [13] described a technique to repair both the MCL and POL. Medial stability according to the International Knee Documentation Committee (IKDC) score was normal or nearly normal (Grade A or B) in 98% of patients and the overall IKDC score improved in these patients from 5% preoperatively to 74% with Grade A or B at followup.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussioncontrasting

confidence: 46%

Section: Introductionmentioning

confidence: 99%

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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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“…Because the majority of previously described techniques are more slingtype procedures [2,7,10] and do not reproduce the native anatomy of the medial knee, the ability to initiate early knee motion is compromised. Similar to the reconstruction history of the cruciate ligaments and the posterolateral aspect of the knee, over time, surgeons have strived to develop more anatomic reconstructions over sling procedures due to improved outcomes with more objective measurement techniques.…”

Section: Discussionmentioning

confidence: 99%

Surgical Technique: Development of an Anatomic Medial Knee Reconstruction

LaPrade

Wijdicks

2012

Clinical Orthopaedics &Amp; Related Research

172

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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“…[2][3][4] When autograft was used for MCL reconstruction, the semitendinosus was the exclusive autologous graft choice described. [5][6][7] The disadvantages of using allografts for reconstructing the knee ligaments relate to financial costs, 8 concerns regarding tissue quality with slower biological incorporation, 9 disease transmission, 10 and some evidence of higher failure rates and inferior functional outcomes in young active adults, at least for the ACL. 11 The potential disadvantages of using autologous hamstring for reconstructing the MCL in the ACL-deficient knee include weakening of the hamstring's anterior restraining action.…”

mentioning

confidence: 99%

Combined Reconstruction of the Medial Collateral Ligament and Anterior Cruciate Ligament Using Ipsilateral Quadriceps Tendon–Bone and Bone–Patellar Tendon–Bone Autografts

Hetsroni¹,

Mann²

2016

Arthroscopy Techniques

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Abstract:The exclusive autograft choice for medial collateral ligament (MCL) reconstruction that has been described until today is the semitendinosus tendon. However, this has some potential disadvantages in a knee with combined MCLeanterior cruciate ligament (ACL) injury, including weakening of the hamstring's anterior restraining action in an already ACL-injured knee and nonanatomic distal MCL graft insertion when leaving the semitendinosus insertion intact at the pes anserinus during reconstruction. Moreover, because some surgeons prefer to use the hamstring for autologous ACL reconstruction, the contralateral uninjured knee hamstring needs to be harvested as a graft source for the MCL reconstruction if autografts and not allografts are the surgeons' preference. We describe a technique for performing combined reconstruction of the MCL and ACL using ipsilateral quadriceps tendonebone and boneepatellar tendonebone autografts. This technique of MCL reconstruction spares the hamstring tendons and benefits from the advantage provided by bone-to-bone healing on the femur with distal and proximal MCL tibial fixation that closely reproduces the native MCL tibia insertion.

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Anatomical Reconstruction of the Medial Collateral Ligament and Posteromedial Corner of the Knee in Patients With Chronic Medial Collateral Ligament Instability

Abstract: Acceptable clinical results with the MCL reconstruction technique were achieved in patients suffering from chronic valgus instability.

Cited by 240 publications

References 23 publications

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

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

Surgical Technique: Development of an Anatomic Medial Knee Reconstruction

Combined Reconstruction of the Medial Collateral Ligament and Anterior Cruciate Ligament Using Ipsilateral Quadriceps Tendon–Bone and Bone–Patellar Tendon–Bone Autografts

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