Neuromuscular recovery pattern after medial collateral ligament disruption in rats

2009 ◽  
Vol 107 (1) ◽  
pp. 98-104 ◽  
Author(s):  
Jérôme Laurin ◽  
Erick Dousset ◽  
Serge Mesure ◽  
Patrick Decherchi
Keyword(s):  
Medial Collateral Ligament ◽  
Stance Phase ◽  
Amplitude Ratio ◽  
Joint Damage ◽  
Afferent Fiber ◽  
Vastus Medialis ◽  
Knee Angle ◽  
Collateral Ligament ◽  
Vastus Medialis Muscle ◽  
Afferent Response

The medial collateral ligament (MCL) is one of the most injured ligaments during sport activities. The resulting joint damage effects on neuromuscular system remain unclear. Thus this study was designed to assess the changes in neuromuscular properties of vastus medialis muscle after MCL transection. Complete rupture of MCL was performed on rats, and dynamic functional assessment during locomotion was achieved before and once a week from 1–5 wk postlesion. Twitch properties and metabo- and mechanosensitive afferent fiber responses to specific stimuli were measured 1, 3, and 5 wk after MCL transection. Results indicated that maximum knee angle measured during the stance phase of the gait cycle was decreased during 3 wk after MCL injury and then recovered. Minimum knee angle measured during the stance phase was decreased during 2 wk and showed compensatory effects at week 5. A stepwise decrease in maximum relaxation rate-to-amplitude ratio concomitant with a stepwise increase in half-relaxation time were observed following MCL injury. Variations in metabosensitive afferent response to chemical (KCl and lactic acid) injections were decreased at week 1 and recovered progressively from week 3 to week 5 postlesion. Recovery of the mechanosensitive afferent response to vibrations was not totally complete after 5 wk. Our data indicate that alteration of the sensory pathways from the vastus medialis muscle could be considered as a source of neuromuscular deficits following MCL transection. Our results should be helpful in clinical purpose to improve the knowledge of the influence exerted by ligament rupture on the motor system and permit development of rehabilitation protocols and exercises more appropriate for recovery of functional stability.

scholarly journals The irreducible knee-luxation after low-velocity trauma

2019 ◽  
Vol 7 (6_suppl4) ◽  
pp. 2325967119S0024
Author(s):  
Kai Fehske ◽  
Martin Jordan ◽  
Rainer Meffert
Keyword(s):  
Medial Collateral Ligament ◽  
Subcutaneous Fat ◽  
The Elderly ◽  
Lateral Side ◽  
Vastus Medialis ◽  
Collateral Ligament ◽  
Low Velocity ◽  
Functional Rehabilitation ◽  
Medial Condyle ◽  
Tibial Head

Aims and Objectives: Knee-luxations are severe and rare injuries. Within the last years there is an incline on low velocity trauma leading to a nee-luxation. The luxated knee should be reduced immediately to minimize collateral damage to soft-tissue structures, nerves, vessels, etc. Materials and Methods: We report about a 87-year old man who was brought to our emergency room after he fell out of his bed. He showed a to the lateral side luxated tibial-head, which could not be reduced in analog sedation. The foot pulses could be measured with the Doppler, the patient was under massive pain so we decided to perform an immediate operative intervention. Even under maximum relaxtion the knee stayed in medial luxation. Results: The open reposition showed the destruction of all medial structures including the subcutaneous fat. The medial condyle was completely uncovered. The sartorious fascia, the ruptured M. vastus medialis and fibres of the medial collateral ligament have been trapped in the medial tibial joint line. The reposition was made possible by incision of the sartorious fascia. The tibially ruptured acl was refixated in a modified canula technique, the medial structures were adapted with sutures and additionally stabilized with ligament bracing for the medial collateral ligament. Postoperatively, the knee was immobilized in an external fixation for two week. Afterward we started with functional rehabilitation. The postoperatively obtained CT-angiography showed now traumatic vascular damage. This case is completely foto-documented. Conclusion: The irreducible knee-luxations are rare complications. So far there are 4 cases published. In all cases there has been an interposition of the musculus vastus medialis an the surrounding structures. An immediate open intervenvtion to reposition the knee has to be performed to avoid severe damage to. Especially the elderly patient benefits from a single-staged procedure to reconstruct the ruptured ligaments. To realize the best outcome early functional rehabilitation under close supervision of the surgeon is necessary.

scholarly journals In vivo length patterns of the medial collateral ligament during the stance phase of gait

2010 ◽  
Vol 19 (5) ◽  
pp. 719-727 ◽  
Author(s):  
Fang Liu ◽  
Hemanth R. Gadikota ◽  
Michal Kozánek ◽  
Ali Hosseini ◽  
Bing Yue ◽  
...  
Keyword(s):  
Medial Collateral Ligament ◽  
Stance Phase ◽  
Collateral Ligament

scholarly journals Illustration of the connection between the vastus medialis obliquus muscle and the superficial medial collateral ligament of the knee: A human knee cadaveric study

2021 ◽  
Vol 12 (1) ◽  
pp. 431-438
Author(s):  
Mohamed Hamid Awadelseid
Keyword(s):  
Medial Collateral Ligament ◽  
Knee Extension ◽  
Distal Portion ◽  
Vastus Medialis ◽  
Collateral Ligament ◽  
Valgus Stress ◽  
Vastus Medialis Obliquus ◽  
Human Knee ◽  
Superficial Medial Collateral Ligament ◽  
The Mean

Background: While the anatomy of the medial part of the knee has been extensively described, the muscular connections to the superficial medial collateral ligament (sMCL) have not been sufficiently studied. The purpose of this study is to describe the anatomy of the musculo-ligamentous connection between the sMCL and the Vastus Medialis Obliquus muscle (VMO), and to describe its anatomy. Methods: Six Human Cadaveric knees were used in this study. Donors were 4 males and 2 females with a mean age of 49 years old. Dissection was performed in fixed knee extension and directed to show the area of the proximal attachment of the sMCL. Results: A musculo ligamentous connection between the distal portion of the Vastus medialis Obliquus muscle and the sMCL has been identified in our entire specimens. The mean mid substance width of this connection was 9.75 (8.7 -10.8) mm, the mean length was 29.3 (22.2-36.4) mm and the mean thickness was 1.3 (0.9-1.7) mm. Conclusion: The proximal femoral attachment of the sMCL is directly connected to the distal end of VMO. This connection may show that the sMCL can possibly assist in the dynamic stabilization of the knee during extension against valgus stress, through its tension by the contracted VMO muscle.

scholarly journals IS PERCUTANEOUS MEDIAL COLLATERAL LIGAMENT (MCL) RELAXATION DURING ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION A SAFE OPTION FOR GAINING ACCESS TO THE MEDIAL KNEE COMPARTMENT IN CHILDREN?

2021 ◽  
Vol 9 (7_suppl3) ◽  
pp. 2325967121S0004
Author(s):  
John A. Schlechter ◽  
Tanner Harrah ◽  
Bryn Gornick ◽  
Benjamin Sherman
Keyword(s):  
Anterior Cruciate Ligament ◽  
Children And Adolescents ◽  
Medial Collateral Ligament ◽  
Cruciate Ligament ◽  
Adult Population ◽  
Deep Infection ◽  
Patient Reported Outcome ◽  
Collateral Ligament ◽  
Patient Reported ◽  
Anterior Cruciate

Introduction: With participation in youth sports anterior cruciate ligament (ACL) injuries are a common occurrence. Nearly 70% of ACL tears in children and adolescents have an associated meniscus tear. Percutaneous medial collateral ligament (MCL) relaxation has been described as utilitarian in accessing the medial meniscus for diagnostic assessment and treatment in the adult population to increase medial compartment working space in arthroscopic surgery. The technique has not been evaluated in the pediatric population. The purpose of this study was to compare the outcomes of children and adolescents that underwent anterior cruciate ligament reconstruction (ACLR) with and without percutaneous relaxation of the medial collateral ligament (MCL) for meniscal tear management. Methods: A retrospective review was performed of patients aged 8 to 19 years old that had undergone knee arthroscopy for an (ACLR) with meniscus pathology. Those that underwent MCL relaxation were grouped together and compared to a matched cohort that did not have MCL relaxation performed. Preoperative, operative and postoperative data was analyzed. The primary measurement was obtained using a validated patient reported outcome score (Pedi-IKDC), secondary outcome measures were defined as superficial or deep infection, saphenous nerve dysesthesias, ACL graft failure and return to the operating room. Statistical analysis of the two cohorts was performed. Results: Fifty-four patients were included in the study (27 in each group) with average age 15 years (range 10-19). Average follow-up for the MCL relaxation group was 22.4 months versus 58 months for the non-MCL relaxation group. The average Pedi-IKDC score was 93.3 for the MCL relaxation group and 91.4 for the non-MCL relaxation group (p=0.34). There was no difference in patient demographics, return to the operating room (p=0.49), saphenous nerve dysesthesia (p=0.49), superficial or deep infection (p=0.32). Conclusion: ACL reconstruction in children and adolescents with MCL relaxation for the management of medial meniscal tears appears to be a safe option. Equivocal patient reported outcome scores as compared to the control group were found with no increase in post-operative complications. In children with ACL tears, appropriate diagnosis and management of medial meniscal pathology is important to maintain secondary restraint to anterior tibial translation and prevent premature graft failure. Pediatric knees can have tight medial compartments, making access difficult, potentially leading to poor visualization and iatrogenic chondral damage. Percutaneous medial collateral ligament (MCL) relaxation has been described in the adult population to increase medial compartment working space without long term sequela. We report similar findings in an all pediatric cohort.

scholarly journals Medial collateral ligament reconstruction graft isometry is effected by femoral position more than tibial position

2021 ◽  
Author(s):  
Christoph Kittl ◽  
James Robinson ◽  
Michael J. Raschke ◽  
Arne Olbrich ◽  
Andre Frank ◽  
...  
Keyword(s):  
Medial Collateral Ligament ◽  
Knee Flexion ◽  
Length Change ◽  
Collateral Ligament ◽  
Complex Behaviour ◽  
Femoral Attachment ◽  
Attachment Sites ◽  
Custom Made ◽  
Length Changes ◽  
Graft Length

Abstract Purpose The purpose of this study was to examine the length change patterns of the native medial structures of the knee and determine the effect on graft length change patterns for different tibial and femoral attachment points for previously described medial reconstructions. Methods Eight cadaveric knee specimens were prepared by removing the skin and subcutaneous fat. The sartorius fascia was divided to allow clear identification of the medial ligamentous structures. Knees were then mounted in a custom-made rig and the quadriceps muscle and the iliotibial tract were loaded, using cables and hanging weights. Threads were mounted between tibial and femoral pins positioned in the anterior, middle, and posterior parts of the attachment sites of the native superficial medial collateral ligament (sMCL) and posterior oblique ligament (POL). Pins were also placed at the attachment sites relating to two commonly used medial reconstructions (Bosworth/Lind and LaPrade). Length changes between the tibiofemoral pin combinations were measured using a rotary encoder as the knee was flexed through an arc of 0–120°. Results With knee flexion, the anterior fibres of the sMCL tightened (increased in length 7.4% ± 2.9%) whilst the posterior fibres slackened (decreased in length 8.3% ± 3.1%). All fibre regions of the POL displayed a uniform lengthening of approximately 25% between 0 and 120° knee flexion. The most isometric tibiofemoral combination was between pins placed representing the middle fibres of the sMCL (Length change = 5.4% ± 2.1% with knee flexion). The simulated sMCL reconstruction that produced the least length change was the Lind/Bosworth reconstruction with the tibial attachment at the insertion of the semitendinosus and the femoral attachment in the posterior part of the native sMCL attachment side (5.4 ± 2.2%). This appeared more isometric than using the attachment positions described for the LaPrade reconstruction (10.0 ± 4.8%). Conclusion The complex behaviour of the native MCL could not be imitated by a single point-to-point combination and surgeons should be aware that small changes in the femoral MCL graft attachment position will significantly effect graft length change patterns. Reconstructing the sMCL with a semitendinosus autograft, left attached distally to its tibial insertion, would appear to have a minimal effect on length change compared to detaching it and using the native tibial attachment site. A POL graft must always be tensioned near extension to avoid capturing the knee or graft failure.

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