Double-row repair of the distal attachment of the superficial medial collateral ligament: a basic science pilot study

Whelan, Daniel B.; Leiter, Jeff; Sasyniuk, Treny M.; Litchfield, Robert; Randle, John A.; Hughes, Scott; MacDonald, Peter B.

doi:10.1007/s00167-015-3773-7

Cited by 10 publications

(12 citation statements)

References 22 publications

(28 reference statements)

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“…Some differences between the results from the current study and those in the literature may be due to differences in loading. LaPrade et al [24] reported that gap width was measured during the application of a 10 Nm load, as in our study, whereas Kleinbaum and Blankstein [33] and Whelan et al [25] either did not control load or did not report it …”

Section: Figmentioning

confidence: 48%

“…This has clinical implications. For example, there is evidence that MCL-deficient knees show significantly greater values of absolute gap width compared with intact knees [24, 25, 33], and medial gap width may be a suitable method for assessing the efficacy of MCL repair [25]. Varus/valgus instability post-arthroplasty, which has been linked to patient satisfaction [11], and is often assessed clinically with radiographic examination, may also be possible to evaluate with ultrasound, though reverberation artifacts off of the metallic prosthesis [41] may make gap width measures more challenging in these cases.…”

Section: Discussionmentioning

confidence: 99%

“…There are some quantitative approaches for measuring knee laxity; one of the most common involves the fluoroscopic imaging of the knee under valgus stress with the post-hoc analysis of tibiofemoral joint angle [20–23], medial gapping [24, 25] or the ratio between gapping in the knee of interest and the contralateral knee [26]. With these methods, researchers have shown differences in valgus laxity for patients receiving unicompartmental knee arthroplasty via different techniques [21], differences in laxity when stress tests are performed under anesthesia [23], the increase in medial gapping with simulated MCL injury [24, 27], and improvement with MCL repair [25].…”

Section: Introductionmentioning

confidence: 99%

“…With these methods, researchers have shown differences in valgus laxity for patients receiving unicompartmental knee arthroplasty via different techniques [21], differences in laxity when stress tests are performed under anesthesia [23], the increase in medial gapping with simulated MCL injury [24, 27], and improvement with MCL repair [25]. However, despite these successes, some limitations of the approach remain, most notably that fluoroscopy exposes patients to ionizing radiation, which, even in low doses, can increase the risk for cancer [28].…”

Section: Introductionmentioning

confidence: 99%

“…Secondly, the US gap width was compared with measures of gap width that mimicked the gold standard fluoroscopic approach and estimated gap width based on two published methods. In the first mimicked fluoroscopy (mFluoro) approach, the gap was measured at the most medial aspect of the femur (mFluoro-Medial), based on [25], and in the second, the gap was measured at the most distal aspect of the femur (mFluoro-Distal), based on [24]. We hypothesized that the US method would show similar absolute measures of gap width as the mFluoro-Medial method, as both measured gap width at approximately the same anatomical location, and we hypothesized that the change in gap width would be correlated in all three methods.…”

Section: Introductionmentioning

confidence: 99%

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The measurement of medial knee gap width using ultrasound

Slane

Scheys³

2017

Arch Orthop Trauma Surg

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Introduction Medial knee instability is a key clinical parameter for assessing ligament injury and arthroplasty success, but current methods for measuring stability are typically either qualitative or involve ionizing radiation. The purpose of this study was to perform a preliminary analysis of whether ultrasound (US) could be used as an alternate approach for quantifying medial instability by comparing an US method with an approach mimicking the current gold standard fluoroscopy method. Materials and Methods US data from the medial knee were collected while cadaveric lower limbs (n=8) were loaded in valgus (10 Nm). During post-processing, the US gap width was measured by identifying the medial edges of the femur and tibia and computing the gap width between these points. For comparison, mimicked fluoroscopy (mFluoro) images were created from specimen-specific bone models, developed from segmented CT scans, and from kinematic data collected during testing. Then, gap width was measured in the mFluoro images based on two different published approaches, with gap width measured either at the most medial or most distal aspect of the femur. Results Gap width increased significantly with loading (p<0.001), and there were no significant differences between the US method (unloaded: 8.7±2.4 mm, loaded: 10.7±2.2 mm) and the mFluoro method that measured gap width at the medial femur. In terms of the change in gap width with load, no correlation with the change in abduction angle was observed, with no correlation between the various methods. Inter-rater reliability for the US method was high (0.899–0.952). Conclusions Ultrasound shows promise as a suitable alternative for quantifying medial instability without radiation exposure. However, the outstanding limitations of existing approaches and lack of true ground-truth data require that further validation work is necessary to better understand the clinical viability of an US approach for measuring medial knee gap width.

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Section: Figmentioning

confidence: 48%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The measurement of medial knee gap width using ultrasound

Slane

Scheys³

2017

Arch Orthop Trauma Surg

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Treatment of MCL Injury in Combined ACL/MCL Injury

Whelan

Chowdhry

Hantes

et al. 2017

Controversies in the Technical Aspects of ACL Reconstruction

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Ultrasound-based examination of the medial ligament complex shows gender- and age-related differences in laxity

Lutz¹,

Feucht

Wechselberger

et al. 2020

Knee Surg Sports Traumatol Arthrosc

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Purpose Ultrasound (US) examination of the medial joint space of the knee has played a subordinate diagnostic role up till now. The purpose of the present study was to describe mean values of medial joint width and to investigate the impact of gender, age, and body mass index (BMI) on medial joint laxity in healthy knees using modern, dynamic US in a standardized fashion in unloaded and standardized loaded conditions. Methods A total of 65 subjects with 79 healthy knees were enrolled in this study. All volunteers underwent clinical examination of the knee. The medial knee joint width was determined using US in a supine position at 0° and 30° of knee flexion in unloaded and standardized loaded (= 15 Dekanewton, daN) conditions using a specific device. Mean values were described and correlations between medial knee joint width and gender, age, and BMI were assessed. Results Thirty-two females and 33 males were enrolled in this study. The mean medial joint width in 0° unloaded was 5.7 ± 1.2 mm and 7.4 ± 1.4 mm loaded. In 30° of knee flexion, the mean medial joint width was 6.1 ± 1.1 mm unloaded and 7.8 ± 1.2 mm loaded. The average change between unloaded and loaded conditions in 0° was 1.7 ± 1.0 mm and in 30° 1.7 ± 0.9 mm. A significant difference between genders was evident for medial joint width in 0° and 30° of flexion in unloaded and loaded conditions (p < 0.05). With rising age, a significant increased change of medial joint space width between unloaded and loaded conditions could be demonstrated in 0° (p = 0.032). No significant correlation between BMI and medial joint width in US could be found. Conclusion Mean values of medial joint width in unloaded and standardized loaded conditions using a fixation device could be demonstrated. Based on the results of this study, medial knee joint width in US is gender- and age-related in healthy knees. These present data may be useful for evaluating patients with acute or chronic pathologies to the medial side of the knee. Level of evidence III.

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Double-row repair of the distal attachment of the superficial medial collateral ligament: a basic science pilot study

Cited by 10 publications

References 22 publications

The measurement of medial knee gap width using ultrasound

The measurement of medial knee gap width using ultrasound

Treatment of MCL Injury in Combined ACL/MCL Injury

Ultrasound-based examination of the medial ligament complex shows gender- and age-related differences in laxity

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