Medial Collateral Ligament Recession for Chronic Medial Knee Laxity

2012 ◽  
Vol 26 (03) ◽  
pp. 179-184
Author(s):  
Roger Wiltfong ◽  
Robert Steensen ◽  
Jeffrey Backes
Keyword(s):  
Medial Collateral Ligament ◽  
Knee Laxity ◽  
Collateral Ligament ◽  
Medial Knee

scholarly journals Tibial Avulsion with Intra-Articular Entrapment of Medial Collateral Ligament with Posterior Cruciate Ligament Tear with Posterior Root Medial Meniscus Tear: A Case Report of an Unusual Injury Triad

2021 ◽  
Vol 11 (8) ◽  
Author(s):  
Ishan Shevate ◽  
Girish Nathani ◽  
Ashwin Deshmukh ◽  
Anirudh Kandari
Keyword(s):  
Case Report ◽  
Medial Collateral Ligament ◽  
Medial Meniscus ◽  
Cruciate Ligament ◽  
Stress Test ◽  
Joint Line ◽  
Posterior Root ◽  
Collateral Ligament ◽  
Valgus Stress ◽  
Medial Knee

Introduction: The medial collateral ligament (MCL) is the most commonly injured ligament of the knee joint; however, its displacement into the medial knee compartment is rare. Traumatic posterior root of medial meniscus (PRMM) tears are commonly found in high-grade injuries involving anterior cruciate ligament (ACL) or posterior cruciate ligament (PCL) tears along with MCL tears. Diagnosis of these injuries can be made by a preoperative magnetic resonance imaging (MRI), but they can be missed at times due to severe soft-tissue swelling in the acute phase. Case Report: A 25-year-old gentleman presented with injury to the front of his left knee 5 days back. On examination, he had a Grade 3 effusion with valgus stress test and posterior drawer test being positive and medial joint line tenderness was present. A firm localized swelling was palpable on the medial joint line. MRI scan revealed a mid-substance PCL tear, ACL sprain, PRMM tear, and tibial side rupture of superficial MCL with proximally migrated wavy MCL fibers lying below the medial meniscus confirmed on arthroscopy. Medial meniscus root repair by pull through technique and PCL reconstruction with a 3-strand peroneus longus graft followed by open MCL repair with augmentation using a semitendinosus graft was performed. Postoperatively, the knee was kept in a straight knee brace for 4 weeks, followed by a hinged knee brace and appropriate physiotherapy were started. At 2 years follow-up, the patient had attained full range of knee motion with good quadriceps strength, tibial step off maintained, and negative posterior drawer test and valgus stress test. Displacement of torn MCL into the medial knee compartment is an extremely rare injury. Proximal or distal avulsion of MCL with intra-articular incarceration has been reported in isolation or associated with ACL tear. Such an injury triad as reported here has not been reported in the literature to the best of our review. Conclusion: In our case, we report a ver

Medial Knee Injury: Part 1, Static Function of the Individual Components of the Main Medial Knee Structures

2009 ◽  
Vol 37 (9) ◽  
pp. 1762-1770 ◽  
Author(s):  
Chad J. Griffith ◽  
Robert F. LaPrade ◽  
Steinar Johansen ◽  
Bryan Armitage ◽  
Coen Wijdicks ◽  
...  
Keyword(s):  
Medial Collateral Ligament ◽  
Knee Flexion ◽  
External Rotation ◽  
Tracking System ◽  
Knee Injuries ◽  
Collateral Ligament ◽  
Medial Knee ◽  
Superficial Medial Collateral Ligament ◽  
The Individual ◽  
Dial Test

Background There is a lack of knowledge on the primary and secondary static stabilizing functions of the posterior oblique ligament (POL), the proximal and distal divisions of the superficial medial collateral ligament (sMCL), and the meniscofemoral and meniscotibial portions of the deep medial collateral ligament (MCL). Hypothesis Identification of the primary and secondary stabilizing functions of the individual components of the main medial knee structures will provide increased knowledge of the medial knee ligamentous stability. Study Design Descriptive laboratory study. Methods Twenty-four cadaveric knees were equally divided into 3 groups with unique sequential sectioning sequences of the POL, sMCL (proximal and distal divisions), and deep MCL (meniscofemoral and meniscotibial portions). A 6 degree of freedom electromagnetic tracking system monitored motion after application of valgus loads (10 N·m) and internal and external rotation torques (5 N·m) at 0°, 20°, 30°, 60°, and 90° of knee flexion. Results The primary valgus stabilizer was the proximal division of the sMCL. The primary external rotation stabilizer was the distal division of the sMCL at 30° of knee flexion. The primary internal rotation stabilizers were the POL and the distal division of the sMCL at all tested knee flexion angles, the meniscofemoral portion of the deep MCL at 20°, 60°, and 90° of knee flexion, and the meniscotibial portion of the deep MCL at 0° and 30° of knee flexion. Conclusion An intricate relationship exists among the main medial knee structures and their individual components for static function to applied loads. Clinical Significance: Interpretation of clinical knee motion testing following medial knee injuries will improve with the information in this study. Significant increases in external rotation at 30° of knee flexion were found with all medial knee structures sectioned, which indicates that a positive dial test may be found not only for posterolateral knee injuries but also for medial knee injuries.

scholarly journals Medial collateral ligament calcification: a rare knee pain entity with literature review

2017 ◽  
Vol 6 (11) ◽  
pp. 205846011773854 ◽  
Author(s):  
Md Abu Bakar Siddiq ◽  
Israt Jahan
Keyword(s):  
Literature Review ◽  
Knee Pain ◽  
Medial Collateral Ligament ◽  
High Frequency ◽  
Imaging Techniques ◽  
Collateral Ligament ◽  
Medial Knee ◽  
X Ray ◽  
Radio Imaging ◽  
Reported Study

Medial knee pain can originate from both osseous and non-osseous soft tissue structures including medial collateral ligament (MCL), creating a raft for patients’ sufferings. Previously published works demonstrated MCL calcification as a rare medial knee pain entity. Alongside physical examination, radio-imaging techniques, namely conventional X-ray, CT/MRI scanning, etc. have been reported to be useful in recognizing MCL calcification. The present study demonstrates MCL calcification in a 60-year-old Asian-Bangladeshi woman, using high frequency diagnostic ultrasonogram and is the first reported study in the literature. To have available literature review, PubMed, Cochrane, Embase, and Scopus databases were used.

Dynamic Restraints of the Medial Side of the Knee: The Semimembranosus Corner Revisited

2019 ◽  
Vol 47 (4) ◽  
pp. 863-869 ◽  
Author(s):  
Christoph Kittl ◽  
Deborah K. Becker ◽  
Michael J. Raschke ◽  
Marcus Müller ◽  
Guido Wierer ◽  
...  
Keyword(s):  
Internal Rotation ◽  
Medial Collateral Ligament ◽  
External Rotation ◽  
Optical Tracking ◽  
Anterior Tibial Translation ◽  
Collateral Ligament ◽  
Posterior Oblique Ligament ◽  
Medial Knee ◽  
Medial Side ◽  
Tibial Translation

Background: Little is known about the dynamic restraints of the semimembranosus muscle (SM). Purpose and Hypothesis: The goal of the present study was to elucidate the role of (1) passive and (2) active restraints to medial-side instability and to analyze (3) the corresponding tightening of the posteromedial structures by loading the SM. It was hypothesized that points 1 to 3 will significantly restrain medial knee instability. This will aid in understanding the synergistic effect of the semimembranosus corner. Study Design: Controlled laboratory study. Methods: Nine knees were tested in a 6 degrees of freedom robotic setup and an optical tracking system. External rotation (ER; 4 N·m), internal rotation (4 N·m), anteromedial rotation (4-N·m ER and 89-N anterior tibial translation), and valgus rotation (8 N·m) were applied at 0°, 30°, 60°, and 90°, with and without an SM load of 75 N. Sequential cutting of the medial collateral ligament and posterior oblique ligament was then performed. At the intact state of the knee and after each cut, the aforementioned simulated laxity tests were performed. Results: The medial collateral ligament was found to be the main passive stabilizer to ER and anteromedial rotation, resulting in 9.3° ± 6.8° ( P < .05), 8.1° ± 3.6° ( P < .05), and 7.6° ± 4.2° ( P < .05) at 30°, 60°, and 90°, respectively. Conversely, after the posterior oblique ligament was cut, internal rotation instability increased significantly at early flexion angles (9.3° ± 3.2° at 0° and 5.2° ± 1.1 at 30°). Loading the SM had an overall effect on restraining ER ( P < .001) and anteromedial rotation ( P < .001). This increased with flexion angle and sectioning of the medial structures and resulted in a pooled 2.8° ± 1.7° (not significant), 5.4° ± 2° ( P < .01), 7.5° ± 2.8° ( P < .001), and 8.3° ± 4.4° ( P < .001) at 0°, 30°, 60°, and 90° when compared with the unloaded state. Conclusion: The SM was found to be a main active restraint to ER and anteromedial rotation, especially at higher flexion angles and in absence of the main passive medial restraints. The calculated tensioning effect was small in all flexion angles for all simulated laxity tests. Clinical Relevance: A complete semimembranosus avulsion may indicate severe medial knee injury, and refixation should be considered in multiligament injury.

scholarly journals Distension of the Medial Collateral Ligament Bursa of the Knee With Possible Bursitis

2016 ◽  
Vol 33 (1) ◽  
pp. 22-30 ◽  
Author(s):  
Tony Y. Li
Keyword(s):  
Young Adult ◽  
Medial Collateral Ligament ◽  
Knee Injury ◽  
Meniscal Tear ◽  
Fluid Collection ◽  
Collateral Ligament ◽  
Medial Knee ◽  
Meniscofemoral Ligament

The bursitis of the medial collateral ligament (MCL) of the knee is the inflammatory distension of the bursa located between the superficial and deep portions of MCL. Five cases with sonographic findings of suspected MCL bursitis were reviewed. All five cases had fluid collection with distinct and smooth borders between the superficial and deep portions of the MCL. Two of them had the fluid adjacent to the tibia; two of them adjacent to the femur; and one of them spanning the joint. Four of the five patients without recognizable knee injury history and middle third meniscal tear excluded the possibility of injury-related fluid collection. Hence, MCL bursitis is the possible diagnosis. One young adult with a recent knee injury also had a tear in the meniscofemoral ligament of the deep portion of the MCL. The distension of the bursa was interrupted by and directly connected to the tear of the meniscofemoral ligament. Therefore, it is part of the injury but not bursitis. This report describes sonographic characteristics of MCL bursitis that may assist in the diagnosis and differentiate it from other medial knee conditions.

scholarly journals Midterm Outcomes, Complications, and Return to Sports After Medial Collateral Ligament and Posterior Oblique Ligament Reconstruction for Medial Knee Instability: A Systematic Review

2021 ◽  
Vol 9 (11) ◽  
pp. 232596712110560
Author(s):  
Riccardo D’Ambrosi ◽  
Katia Corona ◽  
Germano Guerra ◽  
Simone Cerciello ◽  
Nicola Ursino ◽  
...  
Keyword(s):  
Systematic Review ◽  
Postoperative Complications ◽  
Medial Collateral Ligament ◽  
Functional Outcomes ◽  
Return To Sports ◽  
Recreational Sports ◽  
Collateral Ligament ◽  
Valgus Stress ◽  
Posterior Oblique Ligament ◽  
Medial Knee

Background: In cases of multiple ligaments or medial collateral ligament (MCL) reconstruction, restoring the native anatomy of the posterior oblique ligament (POL) to address chronic valgus instability has been attracting increased attention. Purpose: To review the current literature on postoperative outcomes, complications, and return to sports after superficial MCL-POL (sMCL-POL) reconstruction to restore medial knee integrity. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review was conducted based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Two independent reviewers searched the PubMed, Scopus, Embase, and Cochrane Library databases using the terms “posterior oblique ligament,” “posteromedial corner of the knee,” and “reconstruction.” Included were studies that reported postoperative clinical and functional outcomes in patients who had undergone a combined sMCL-POL reconstruction for medial knee instability. The authors evaluated surgical technique, rehabilitation protocol, postoperative outcomes (Lysholm, International Knee Documentation Committee [IKDC], and Tegner scores and valgus stress radiograph), and return to sports and complication rates across the included studies. Results: A total of 6 studies were reviewed. The cohort consisted of 199 patients (121 men and 78 women), with a mean age of 32.7 ± 3.9 years (range, 27.4-36.6 years). The Lysholm and IKDC scores improved from pre- to postoperatively (Lysholm, from 67.2 ± 20.4 to 89.4 ± 3; IKDC, from 45.8 ± 2.1 to 84.8 ± 7.5). The Tegner score produced satisfactory results, from a preoperative mean of 3.3 ± 2.4 to 6.3 ± 0.9 postoperatively. The medial joint opening on valgus stress radiographs ranged from 7.5 ± 1.1 mm preoperatively to 3 ± 3.1 mm postoperatively. After passing activity-specific functional and clinical tests, 88% to 91.3% of the patients were reported to have returned to recreational sports within 6 to 12 months postoperatively, whereas 10% of the patients developed postoperative complications. Conclusion: Satisfactory clinical and functional outcomes, a high rate of return to recreational sports, and a low rate of postoperative complications were reported after an sMCL-POL reconstruction to restore medial knee integrity.

Medial Knee Injury

2009 ◽  
Vol 37 (9) ◽  
pp. 1771-1776 ◽  
Author(s):  
Coen A. Wijdicks ◽  
Chad J. Griffith ◽  
Robert F. LaPrade ◽  
Stanislav I. Spiridonov ◽  
Steinar Johansen ◽  
...  
Keyword(s):  
Medial Collateral Ligament ◽  
External Rotation ◽  
Load Sharing ◽  
Collateral Ligament ◽  
Knee Ligament ◽  
Posterior Oblique Ligament ◽  
Medial Knee ◽  
Intact State ◽  
Superficial Medial Collateral Ligament ◽  
Load Increase

Background There is limited information regarding directly measured load responses of the posterior oblique and superficial medial collateral ligaments in isolated and multiple medial knee ligament injury states. Hypotheses Tensile load responses from both the superficial medial collateral ligament and the posterior oblique ligament would be measurable and reproducible, and the native load-sharing relationships between these ligaments would be altered after sectioning of medial knee structures. Study Design Descriptive laboratory study. Methods Twenty-four nonpaired, fresh-frozen adult cadaveric knees were distributed into 3 sequential sectioning sequences. Buckle transducers were applied to the posterior oblique ligament and the proximal and distal divisions of the superficial medial collateral ligament; 10 N·m valgus moments and 5 N·m internal and external rotation torques were applied at 0°, 20°, 30°, 60°, and 90° of knee flexion. Results With an applied valgus and external rotation moment, there was a significant load increase on the posterior oblique ligament compared with the intact state after sectioning all other medial knee structures. With an applied external rotation torque, there was a significant load decrease on the proximal division of the superficial medial collateral ligament from the intact state after sectioning all other medial knee structures. With an applied external rotation torque, the distal division of the superficial medial collateral ligament experienced a significant load increase from the intact state after sectioning the posterior oblique ligament and the meniscofemoral division of the deep medial collateral ligament. Conclusion This study found alterations in the native load-sharing relationships of the medial knee structures after injury. Sectioning both the primary and secondary restraints to valgus and internal/external rotation of the knee alters the intricate load-sharing relationships that exist between the medial knee structures. Clinical Significance In cases in which surgical repair or reconstruction is indicated, consideration should be placed on repairing or reconstructing all injured medial knee structures to restore the native load-sharing relationships among these medial knee structures.

The Role of the Medial Collateral Ligament and Posteromedial Capsule in Controlling Knee Laxity

2006 ◽  
Vol 34 (11) ◽  
pp. 1815-1823 ◽  
Author(s):  
James R. Robinson ◽  
Anthony M. J. Bull ◽  
Rhidian R. deW. Thomas ◽  
Andrew A. Amis
Keyword(s):  
Medial Collateral Ligament ◽  
Knee Laxity ◽  
Collateral Ligament ◽  
Posteromedial Capsule

scholarly journals Overstride-Induced Medial Knee Desmopathy: An Exploration Case Series

2020 ◽  
Vol 55 (12) ◽  
pp. 1255-1261
Author(s):  
Reid Fisher ◽  
Nathaniel S. Nye ◽  
Joanna Soles ◽  
Andy Waldhelm ◽  
Ryan Gottfredson
Keyword(s):  
Knee Pain ◽  
Medial Collateral Ligament ◽  
Case Series ◽  
Saphenous Nerve ◽  
Collateral Ligament ◽  
Short Term ◽  
Medial Knee ◽  
Bone Stress ◽  
Stress Injuries

Nine runners with varied experience but similar running-gait forms presented with the insidious and progressive onset of medial knee pain. Functional tightness of the semimembranosus (SM) tendon appeared to be a concomitant factor in the pain presentation of these patients. When evaluating atraumatic medial knee pain in runners, clinicians must consider bone stress injuries and atypical conditions. A functionally tight SM may induce pain and desmopathy of the medial collateral ligament through direct fiber entanglement or cause entrapment of infrapatellar branches of the saphenous nerve or both. Relieving SM tension resulted in short-term pain reduction while eliminating the overstride during the running gait over the long term appeared to prevent recurrence.

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