Concomitant reconstruction of the medial collateral and posterior oblique ligaments for medial instability of the knee

169

213

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.

Section: Discussionmentioning

confidence: 99%

Surgical Technique: Development of an Anatomic Medial Knee Reconstruction

LaPrade

Wijdicks

2012

169

213

“…Our technique also saves the synergistic action of the posterior medial complex and the ACL [19]. The medial side should not be overlooked in chronic combined anteromedial instabilities when a residual laxity is observed after ACL fixation: in these patients, a medial ligamentous plasty can reduce stress on the reconstructed ACL [10]. Repair of all injured medial knee ligaments can ease the restoration of physiologic load sharing among these structures, which may be a factor for decreasing the risk of reinjury.…”

Section: Discussionmentioning

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

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).

“…Most MCL sprains do not warrant surgical treatment [1,2,5]. However, numerous authors have suggested specific locations of rupture may warrant different treatment regimens [1,2,4,5].…”

Section: Introductionmentioning

confidence: 99%

Case Reports: A Stener-like Lesion of the Medial Collateral Ligament of the Knee

Corten

Hoser²,

Fink³

et al. 2010

When the superficial fibers of the medial collateral ligament of the knee are torn without tearing of the deep fibers, the anterior superficial fibers may displace over the pes anserinus tendons, so that healing back to the tibial insertion site may be jeopardized. As only the anterior superficial and not the posterior superficial or deep fibers are disrupted, the knee will not have increased valgus laxity in extension whereas there is not a firm end point in 30°flexion. The clinical findings could be confused with those of a Grade 2 medial collateral ligament sprain that generally is not associated with displacement of the anterior fibers over the pes anserinus tendons. We describe the diagnostic findings confirmed with surgical exploration of two Stener-like disruptions of the medial collateral ligament of the knee.