The effect of healing in the medial collateral ligament of human knee joint: A three-dimensional finite element analysis

Abstract

The medial collateral ligament (MCL) is one of the main ligaments that provide knee joint with major restraints against valgus, internal, and external torque loads. The MCL injury most frequently occurs near its femoral attachment but can be healed spontaneously. Hence, the usual clinical treatment for MCL injury is conservative therapy with early controlled rehabilitation motion. However, the effect of the variations in the healing conditions of the MCL portion (i.e. near the femoral insertion) is still unclear. In this study, finite element tibiofemoral joint models with three different MCL healing conditions were analyzed under six kinds of joint loads, such as 10 and 20 N·m valgus tibial torques, 5 and 10 N·m internal tibial torques, and 5 and 10 N·m external tibial torques. The three healing conditions corresponded to the early, medium, and final (i.e. healthy) stages of the healing period, respectively. It was found that different MCL healing conditions greatly affected the main joint kinematics under valgus tibial torques, but neither the reaction force nor stress results of the MCL. The peak strain values in the MCL healing portion changed greatly under all the six loads. Moreover, all the joint kinematics, strain results, and reaction force of the MCL at the medium stage were similar to those in the healthy joint, that is, at the final healing stage. These imply that the partially healed MCL might be enough for providing the restraints for knee joints and would not lead to some high strains occurring in the MCL.

In Vivo biomechanical evaluations of suture anchors for repairing grade 3 superficial medial collateral ligament injury in a porcine model

“…However, in their finite element study, Wan et al had described that a partially healed sMCL might be sufficient for providing restraints for the knee joints and would not lead to the occurrence of high strains in the sMCL. 26 Sixth, this study did not establish a minimal clinically important difference 31 of MRI-derived SNQs, and it remains unclear whether this surgical technique can recover the SNQ to that of the native sMCL after longterm follow-up. Determining this is necessary to clarify the effects on ligament healing and maturation.…”

“…We used an ultimate load to failure test that represented the load increase in unintentionally performed movements. 26 Failure of the repaired sMCLs by tensile testing exhibited no ligament mid-substance tearing, but femoral attachment avulsion was observed in all model animals, as was failure of the sham sMCL repair. Additionally, there were no significant differences in structural properties (i.e., upper yield load, maximum load, linear stiffness, and elongation at failure) between the repaired and sham sMCL groups.…”

Stress response envelopes of intact tibiofemoral joint and knee osteoarthritis

“…The prevalence of knee pain increased with age and was highest among the older residents aged 60-69 years and the prevalence was higher among females than males. 3 While computational stress analysis of the knee joint has been reported in several publications, [4][5][6][7][8][9][10][11][12][13][14][15] there are still many aspects that require more investigation. The first aim of this study was to determine stress envelopes of an intact tibiofemoral joint in response to different axial load levels, external-internal rotation and varusvalgus motion scenarios.…”

Collateral ligament injuries in horses

“…Results from a study in which modelling of human knee medial collateral ligament damage was performed indicate that joint kinematics are altered by such injuries, particularly during the early period of healing (Wan et al . ). Decisions regarding the choice of surgical or conservative management for human patients with collateral ligament injury are primarily made on the basis of presence of joint instability (Phisitkul et al .…”