Superficial Medial Collateral Ligament Anatomic Augmented Repair Versus Anatomic Reconstruction

Wijdicks, Coen A.; Michalski, Max; Rasmussen, Matthew T.; Goldsmith, Mary T.; Kennedy, Nicholas I.; Lind, Martin; Engebretsen, Lars; LaPrade, Robert F.

doi:10.1177/0363546513503289

Cited by 79 publications

(77 citation statements)

References 43 publications

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“…3,6 In regard to diagnosis, stress radiographs should be used in all patients with a clinical suspicion of a medial side injury. LaPrade et al 8 reported that the amount of medial compartment gapping can be quantified on valgus stress radiographs for medial knee injuries in the acute and chronic settings.…”

Section: Discussionmentioning

confidence: 99%

“…Both techniques have been shown to restore normal laxity of the joint in the most tested conditions. 3,6 Long-term studies should be performed to ensure the maintenance of the restoration, stability, and functionality of the knee. We encourage other groups to test the validity of this technique to assess for long-term results.…”

Section: Discussionmentioning

confidence: 99%

“…Proximally, the incision is performed between the adductor tubercle (AT) and the medial aspect of the patella, and extending distally over the midportion of the tibia approximately 7 to 8 cm distal to the joint line. 3,6,7 In cases of concomitant ACL or posterior cruciate ligament injury, this approach facilitates the creation of the tibial tunnels for cruciate ligament reconstruction. Care must be taken to avoid the saphenous nerve, which courses 5 cm posteriorly to the AT.…”

Section: Techniquementioning

confidence: 99%

“…Ideally, a remnant of the distal insertion of the sMCL is identified 6 or 7 cm distal to the joint line on the posterior aspect of the medial tibia. 3,4,6,7 The use of a spinal needle marking the medial joint line and a ruler helps the surgeon to identify this point (Fig 3). After measuring the distance, 2 double-loaded suture anchors (Mitek, Westwood, MA) are then fixed.…”

Section: Techniquementioning

confidence: 99%

“…4,5 Anatomic and biomechanical studies have been performed to examine the insertion sites and the functionality of the individual components of the medial structures of the knee to ultimately develop an anatomical augmentation technique. 6,7 The purpose of this study was to describe an anatomic augmentation technique for the sMCL with semitendinosus and gracilis tendon autografts.…”

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confidence: 99%

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Superficial Medial Collateral Ligament of the Knee: Anatomic Augmentation With Semitendinosus and Gracilis Tendon Autografts

Cruz

Olivetto

Dean

et al. 2016

Arthroscopy Techniques

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The superficial medial collateral ligament (sMCL) and associated knee structures are the most commonly injured structures of the knee. Most isolated sMCL tears are treated nonoperatively. Several studies have described different algorithms for treatment of sMCL lesions, as well as different types of techniques, both in the acute and in chronic settings. The purpose of this article was to detail our anatomic sMCL augmentation technique using semitendinosus and gracilis tendon autografts.S uperficial medial collateral ligament (sMCL) tears represent more than one-third of knee injuries.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Techniquementioning

confidence: 99%

Section: Techniquementioning

confidence: 99%

mentioning

confidence: 99%

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Superficial Medial Collateral Ligament of the Knee: Anatomic Augmentation With Semitendinosus and Gracilis Tendon Autografts

Cruz

Olivetto

Dean

et al. 2016

Arthroscopy Techniques

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High strains near femoral insertion site of the superficial medial collateral ligament of the Knee can explain the clinical failure pattern

Luyckx

Verstraete

Roo

et al. 2016

Journal Orthopaedic Research

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The three dimensional (3D) deformation of the superficial medial collateral ligament (sMCL) of the knee might play an important role in the understanding of the biomechanics of sMCL lesions. Therefore, the strain and deformation pattern of the sMCL during the range of motion were recorded in five cadaveric knees with digital image correlation. During knee flexion, the sMCL was found to deform in the three planes. In the sagittal plane, a rotation of the proximal part of the sMCL relative to the distal part occurred with the center of this rotation being the proximal tibial insertion site of the sMCL. This deformation generated high strains near the femoral insertion site of the sMCL. These strains were significantly higher than in the other parts and were maximal at 90° with on average +3.7% of strain and can explain why most lesions in clinical practice are seen in this proximal region. The deformation also has important implications for sMCL reconstruction techniques. Only a perfect anatomic restoration of the insertion sites of the sMCL on both the proximal and distal tibial insertion sites will be able to reproduce the isometry of the sMCL and thus provide the adequate stability throughout the range of motion. The fact that knee motion between 15° and 90° caused minimal strain in the sMCL might suggest that early passive range of motion in physical therapy postoperatively should have little risk of stretching a graft out in the case of an anatomical reconstruction. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:2016-2024, 2016.

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Condylar‐Stabilized TKR May Not Fully Compensate for PCL‐Deficiency: An In Vitro Cadaver Study

Willing

Moslemian

Yamomo

et al. 2019

Journal Orthopaedic Research

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Increased‐congruency bearing options are widely available in numerous total knee replacement (TKR) systems, with the intended purpose of compensating for posterior‐cruciate ligament (PCL) deficiency. However, their ability to provide adequate stability in this setting has been debated. This in vitro joint simulator study measured changes in knee joint kinematics and stability during passive flexion–extension motions and simulated activities of daily living resulting from TKR with condylar‐stabilized (CS) TKR without a PCL versus cruciate‐retaining (CR) TKR. During passive flexion, the CS TKR resulted in a more posterior tibial positioning than both the intact joint and CR TKR (by 3.4 ± 1.0 mm and 4.8 ± 0.7 mm, respectively). With a posterior tibial force applied, the CS TKR tibia was again significantly more posterior than that of the intact joint and CR TKR (by 4.7 ± 1.3 mm and 5.6 ± 0.8 mm, respectively). Furthermore, there were significant differences in the anterior/posterior kinematics of both TKR with respect to intact knees during gait, and differences between the CS and CR TKR during stair ascent and descent. Overall, there appears to be a reduction in anterior–posterior stability of the PCL‐deficient CS TKR knee, suggesting that contemporary increased‐congruency bearing surface designs may not adequately compensate for the loss of the PCL. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:2172–2181, 2019

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Superficial Medial Collateral Ligament Anatomic Augmented Repair Versus Anatomic Reconstruction

Abstract: These results suggest that both an anatomic sMCL augmented repair and an anatomic sMCL reconstruction improve knee kinematics compared with a deficient sMCL and provide equivalent joint stability.

Cited by 79 publications

References 43 publications

Superficial Medial Collateral Ligament of the Knee: Anatomic Augmentation With Semitendinosus and Gracilis Tendon Autografts

Superficial Medial Collateral Ligament of the Knee: Anatomic Augmentation With Semitendinosus and Gracilis Tendon Autografts

High strains near femoral insertion site of the superficial medial collateral ligament of the Knee can explain the clinical failure pattern

Condylar‐Stabilized TKR May Not Fully Compensate for PCL‐Deficiency: An In Vitro Cadaver Study

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