Management of Medial Collateral Ligament Insufficiency During Total Knee Arthroplasty with a Screw and Rectangular Spiked Washer: A Case Series of 14 Patients

Abstract

Objective: To describe the technique of primary repair of medial collateral ligament (MCL) insufficiency using a screw and rectangular spiked washer in a case series of 14 patients. Methods: Fourteen patients undergoing MCL repair by a screw and rectangular spiked washer during TKA between March 2018 and March 2019 were retrospectively reviewed. Among them, half injuries were avulsion of the femoral origin, and the other half were MCL laxity. There were 12 women and two men included in the study, with an average age of 63.6 years (range, 49-79 years) at the time of surgery. This series were followed up with a focus on range of motion (ROM), coronal alignment, Hospital for Special Surgery (HSS) knee scores, their subjective sense of joint instability, and related complications. At the last follow-up, function of the MCL was assessed by manually applying a valgus stress to the knee at both 0 and 30 of knee flexion. Results: The mean follow-up time for all patients was 15.6 months (range, 13-20 months). Repair of the MCL was successful in all patients. ROM improved from a mean of 70.7 ± 35.1 before surgery to 103.9 ± 6.8 at latest follow-up (P = 0.001). All patients were able to perform a half squat easily, but none were able to do full squatting. The mean preoperative HSS score was 43.6 ± 13.4 and increased to a mean of 85.6 ± 3.8 postoperatively (P < 0.001). The femorotibial angle improved from a mean of −3.22 ± 9.47 before surgery to a mean of 5.16 ± 3.14 at the final follow-up (P = 0.006). At the time of final follow-up, no patient required revision and manipulation under anesthesia following the index arthroplasty. No radiolucencies or migration were observed in association with the knee prostheses. No displacement of the screw and rectangular spiked washer was found. There were no clinical complications. No patient reported subjective instability of the knee. Upon physical examination, no patient was found to have laxity in the coronal plane in either 30 of flexion or full extension. Conclusions: The screw and rectangular spiked washer is a simple and effective method for treating MCL sufficiency in TKA, and a study with a larger cohort and extended follow-up is requisite to claim its role in preventing coronal instability and component failure.

Impact of intraoperative medial collateral ligament injury on outcomes after total knee arthroplasty: a meta-analysis and systematic review

“…Demographics and clinical outcomes of the included studies were summarized in Tables 1 and 2 . Among the 15 screened citations, nine were cohort studies [ 8 , 10 , 12 , 13 , 20 , 24 , 28 – 30 ], five were retrospective studies [ 9 , 14 , 19 , 22 , 31 ], and one was a case–control study [ 11 ]. A total of 376 knees in the medial collateral ligament injury group were studied in comparison with 5025 knees in the control group with intact medial collateral ligaments.…”

Prostheses option in revision total knee arthroplasty, from the bench to the bedside: (1) basic science and principles

“…There are great controversies regarding the treatment of ligament absence, and highly constrained prostheses, such as RHK, usually provide excellent short-term results in terms of pain relief, immediate weight-bearing, and improved patient-reported functional scales ( 34 , 35 ). Satisfactory outcomes were also observed by hybrid procedures of ligament repair, augmentation, and reconstruction with arthroplasty using low-constraint prostheses for young and active patients ( 36 ).…”