Biomechanical evaluation of a medial knee reconstruction with comparison of bioabsorbable interference screw constructs and optimization with a cortical button

Wijdicks, Coen A.; Brand, Emily; Nuckley, David J.; Johansen, Steinar; LaPrade, Robert F.; Engebretsen, Lars

doi:10.1007/s00167-010-1127-z

Cited by 18 publications

(14 citation statements)

References 38 publications

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“…A suture anchor was placed at this location and the graft was secured at this site, which restored the native proximal tibial attachment of the superficial medial collateral ligament. The strength of the suture anchor reconstruction graft fixation was reportedly comparable to that of the native strength of the proximal division attachment on the tibia [12]. At this point, the knee was flexed to the point where it appeared any concurrent repaired tissues could be maximally flexed to determine the ''safe zone'' ROM, which could be initiated on Postoperative Day 1.…”

Section: Surgical Techniquementioning

confidence: 99%

Surgical Technique: Development of an Anatomic Medial Knee Reconstruction

LaPrade

Wijdicks

2012

Clinical Orthopaedics &Amp; Related Research

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173

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: Surgical Techniquementioning

confidence: 99%

Surgical Technique: Development of an Anatomic Medial Knee Reconstruction

LaPrade

Wijdicks

2012

Clinical Orthopaedics &Amp; Related Research

Self Cite

173

222

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“…Previous studies do not report moment to failure for soft tissue graft reconstruction, but cyclical submaximal loading demonstrated that the construct had sufficient stability to allow early preoperative rehabilitation. 29 Future study using cyclical testing at submaximal loads may yield additional information about the internal brace construct. Unfortunately, time-zero conclusion Posteromedial knee repair with internal bracing is superior to repair alone and is similar to allograft reconstruction for all parameters measured.…”

Section: Limitationsmentioning

confidence: 99%

Biomechanical Analysis of Internal Bracing for Treatment of Medial Knee Injuries

Gilmer¹,

Crall²,

DeLong³

et al. 2016

Orthopedics

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The internal brace technique uses a high-strength suture tie to augment injured tissues or a primary repair, allowing early rehabilitation. Anatomic repair with internal bracing is a novel and promising treatment for femoral-sided medial knee avulsion injuries of the medial collateral ligament and posterior oblique ligament. Unfortunately, biomechanical and clinical data are lacking. To evaluate this technique compared with other treatment options, 3 assays of 9 cadaveric matched pairs (54 knees) were tested to failure at 30° under valgus load in a biomechanical testing apparatus. The primary outcome measure was moment at failure (Nm), with secondary outcome measures of stiffness (Nm/°), valgus angulation at 10 Nm (°), and valgus angulation at failure (°). Repair with internal bracing was compared with the intact state, repair alone, and allograft reconstruction. The mean moment to failure (62.5±24.9 Nm) for internal bracing was significantly lower than that for intact specimens (107.2±39.7 Nm) (P=.009). Mean moment to failure and valgus angle at failure were significantly greater for internal bracing (95±31.9 Nm) than for repair (73.4±27.6 Nm) (P=.05). Internal bracing was similar to reconstruction for the primary outcome measure (53.5±26.3 Nm vs 66.9±28.8 Nm) (P=.227) and for all secondary outcome measures. These findings indicate that posteromedial knee repair with internal bracing for femoral-sided avulsions is superior to repair alone and is similar to allograft reconstruction for all parameters measured; however, this technique did not recreate biomechanical properties equivalent to the intact state. [Orthopedics. 2016; 39(3):e532-e537.].

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“…1 Cortical suspensory fixation has been shown to provide fixation of soft-tissue grafts that is superior to interference screw fixation alone. 9 A particular benefit of this technique is the robust femoral fixation with the ACL Tightrope RT, as well as tibial fixation with either the staple leaving the distal insertion intact or an interference screw for a free graft. The ability to re-tension the graft after cycling the knee through a range of motion is particularly attractive.…”

Section: Discussionmentioning

confidence: 99%

A Technique of Superficial Medial Collateral Ligament Reconstruction Using an Adjustable-Loop Suspensory Fixation Device

Deo

Getgood

2015

Arthroscopy Techniques

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This report describes superficial medial collateral ligament reconstruction of the knee using a novel method of graft fixation with the ACL Tightrope RT (Arthrex, Naples, FL). After tibial fixation with either a standard interference screw or staple, femoral fixation of the semitendinosus tendon is performed with the adjustable-loop suspensory fixation device, which allows for both initial graft tensioning and re-tensioning after cyclical knee range of motion. This provides the ability for the graft to accommodate for resultant soft-tissue creep and stress relaxation, thereby allowing for optimal soft-tissue tension and reduction in laxity at the end of the procedure.

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Biomechanical evaluation of a medial knee reconstruction with comparison of bioabsorbable interference screw constructs and optimization with a cortical button

Cited by 18 publications

References 38 publications

Surgical Technique: Development of an Anatomic Medial Knee Reconstruction

Surgical Technique: Development of an Anatomic Medial Knee Reconstruction

Biomechanical Analysis of Internal Bracing for Treatment of Medial Knee Injuries

A Technique of Superficial Medial Collateral Ligament Reconstruction Using an Adjustable-Loop Suspensory Fixation Device

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