Surgical Technique: Does Mini-invasive Medial Collateral Ligament and Posterior Oblique Ligament Repair Restore Knee Stability in Combined Chronic Medial and ACL Injuries?

Abstract

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).

Naht und Refixation des medialen Kollateralbandkomplexes bei schwerer akuter medialer Instabilität des Kniegelenks

“…Grundsätzlich haben diese erst- bis zweitgradigen Verletzungen aufgrund der extraartikulären Lage des Ligaments ein gutes Heilungspotential [3]. Daher kommen diese Verletzungen in der Regel ohne eine operative Therapie aus [1,3,4,5,6,6,7,8,9]. Eine 6-wöchige Behandlung mit einer beweglichen Knieorthese ist meist ausreichend für eine suffiziente Bandheilung.…”

Medial Collateral Ligament Laxity in Revision ACL Reconstruction

“…Medial compartment opening of above 5 mm is suggestive of Grade 2+ MCL laxity [ 10 ] (Fig. 19.1 ), whereas 10 mm or more medial opening in chronic cases is suggestive of Grade 3+ MCL laxity [ 11 ] (Fig.…”

“…We use this technique in the setting of revision ACL reconstruction when there is mild increased side-to-side laxity in the MCL [ 10 ].…”

“…Surgical technique [ 10 ]: After the ACL graft is fi xed and medial opening of > 5 mm is observed with the use of the arthroscopic probe, a short longitudinal incision over the medial epicondyle is made ( Fig. 19.3 ).…”

“…Weight-bearing is permitted as tolerated from the day after surgery. Recently, in a group of 36 patients with a mean age of 37 years (range, 15-70), who underwent this technique and were followed for more than 2 years, the following outcomes were reported [ 10 ]: mean subjective IKDC score improved from 36 preoperatively to 94 at latest follow-up, mean KOOS improved from 45 preoperatively to 93 postoperatively, MCL reconstruction : This procedure should be reserved for revision ACL cases where Grade 2+ or 3+ medial laxity is detected. Surgical techniques which have been described to reconstruct the MCL include semitendinosus autograft with preservation of the tibial insertion [ 13 -16 ], allograft tissues [ 17 , 18 ], and double-bundle reconstructions [ 8 , 15 , 17 -19 ].…”