Isolated Sectioning of the Medial and Posteromedial Capsular Ligaments in the Posterior Cruciate Ligament-Deficient Knee

1998 ◽  
Vol 26 (3) ◽  
pp. 389-394 ◽  
Author(s):  
Joseph R. Ritchie ◽  
John A. Bergfeld ◽  
Helen Kambic ◽  
Timothy Manning
Keyword(s):  
Posterior Cruciate Ligament ◽  
Medial Collateral Ligament ◽  
Cruciate Ligament ◽  
Tibial Rotation ◽  
Collateral Ligament ◽  
Superficial Medial Collateral Ligament ◽  
Posterior Translation ◽  
Internal Tibial Rotation ◽  
Tibial Translation ◽  
Deficient Knee

This study was undertaken to determine the contribution of various structures in the posterior cruciate ligament-deficient knee in resisting posterior tibial translation. With “isolated” injuries to the posterior cruciate ligament, the amount of posterior translation will decrease with the posterior drawer test as the knee is taken from neutral to internal tibial rotation. The present study was performed to conclusively determine the anatomic structure responsible for this clinical observation. The TestStar device was used to perform single-plane posterior drawer tests in 14 cadaveric knee specimens. The tests were performed with the knee in neutral tibial rotation and in 20° of internal tibial rotation. The intact knee was tested and then the knee was tested after sequential sectioning of the meniscofemoral ligaments, the posterior cruciate ligament, the posteromedial capsule, and the superficial medial collateral ligament. With the knee in neutral rotation, posterior translation continued to increase as each structure was sectioned. With the knee in internal tibial rotation, posterior displacement was significantly less than in neutral rotation for each state until the superficial medial collateral ligament was sectioned; posterior translation was increased after its sectioning. Our data demonstrate that the superficial medial collateral ligament is the structure responsible for a decrease in posterior tibial translation in the posterior cruciate ligament-deficient knee.

scholarly journals Single-Stage Arthroscopic Anterior and Posterior Cruciate Ligament Repairs and Open Medial Collateral Ligament Repair for Acute Knee Dislocation

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Ryo Murakami ◽  
Eisaburo Honda ◽  
Atsushi Fukai ◽  
Hiroki Yoshitomi ◽  
Takaki Sanada ◽  
...  
Keyword(s):  
Posterior Cruciate Ligament ◽  
Medial Collateral Ligament ◽  
Cruciate Ligament ◽  
Knee Injuries ◽  
Knee Dislocation ◽  
Single Stage ◽  
Lateral Condyle ◽  
Ligament Repair ◽  
Collateral Ligament ◽  
Medial Condyle

Till date, there are no clear guidelines regarding the treatment of multiple ligament knee injuries. Ligament repair is advantageous as it preserves proprioception and does not involve grafting. Many studies have reported the use of open repair and reconstruction for multiple ligament knee injuries; however, reports on arthroscopic-combined single-stage anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) repairs are scarce. In this report, we describe a case of type III knee dislocation (ACL, PCL, and medial collateral ligament (MCL) injuries) in a 43-year-old man, caused by contact while playing futsal. On the sixth day after injury, arthroscopic ACL and PCL repairs were performed with open MCL repair. The proximal lesions in the three ligaments that were injured were sutured using no. 2 strong surgical sutures. The ACL was pulled out to the lateral condyle of the femur and fixed using a suspensory fixation device. The PCL was pulled out to the medial condyle of the femur, and the MCL was pulled towards the proximal end of the femur; both were fixed using suture anchors. Early mobilization was performed, and both, clinical and imaging outcomes, were good two years after surgery.

The Biomechanical Effect of Posterior Cruciate Ligament Reconstruction on Knee Joint Function

2003 ◽  
Vol 31 (4) ◽  
pp. 530-536 ◽  
Author(s):  
Thomas J. Gill ◽  
Louis E. DeFrate ◽  
Conrad Wang ◽  
Christopher T. Carey ◽  
Shay Zayontz ◽  
...  
Keyword(s):  
Posterior Cruciate Ligament ◽  
Ligament Reconstruction ◽  
External Rotation ◽  
Cruciate Ligament ◽  
Knee Kinematics ◽  
Posterior Cruciate Ligament Reconstruction ◽  
Cruciate Ligament Reconstruction ◽  
Posterior Translation ◽  
Muscle Loading ◽  
Tibial Translation

Background The effectiveness of posterior cruciate ligament reconstruction in restoring normal kinematics under physiologic loading is unknown. Hypothesis Posterior cruciate ligament reconstruction does not restore normal knee kinematics under muscle loading. Study Design In vitro biomechanical study. Methods Kinematics of knees with an intact, resected, and reconstructed posterior cruciate ligament were measured by a robotic testing system under simulated muscle loads. Anteroposterior tibial translation and internal-external tibial rotation were measured at 0°, 30°, 60°, 90°, and 120° of flexion under posterior drawer loading, quadriceps muscle loading, and combined quadriceps and hamstring muscle loading. Results Reconstruction reduced the additional posterior tibial translation caused by ligament deficiency at all flexion angles tested under posterior drawer loading. Ligament deficiency increased external rotation and posterior translation at angles higher than 60° of flexion when simulated muscle loading was applied. Posterior cruciate ligament reconstruction reduced the posterior translation and external rotation observed in posterior cruciate ligament-deficient knees at higher flexion angles, but differences were not significant. Conclusion Under physiologic loading conditions, posterior cruciate ligament reconstruction does not restore six degree of freedom knee kinematics. Clinical Relevance Abnormal knee kinematics may lead to development of long-term knee arthrosis.

The Effects of a Popliteus Muscle Load on In Situ Forces in the Posterior Cruciate Ligament and on Knee Kinematics

1998 ◽  
Vol 26 (5) ◽  
pp. 669-673 ◽  
Author(s):  
Christopher D. Harner ◽  
Jürgen Höher ◽  
Tracy M. Vogrin ◽  
Gregory J. Carlin ◽  
Savio L-Y. Woo
Keyword(s):  
Posterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Knee Kinematics ◽  
Tibial Rotation ◽  
Posterior Tibial Translation ◽  
Posterior Tibial ◽  
Tibial Translation ◽  
Intact Knee ◽  
Popliteus Muscle

To investigate the effect of simulated contraction of the popliteus muscle on the in situ forces in the posterior cruciate ligament and on changes in knee kinematics, we studied 10 human cadaveric knees (donor age, 58 to 89 years) using a robotic manipulator/universal force moment sensor system. Under a 110-N posterior tibial load (simulated posterior drawer test), the kinematics of the intact knee and the in situ forces in the ligament were determined. The test was repeated with the addition of a 44-N load to the popliteus muscle. The posterior cruciate ligament was then sectioned and the knee was subjected to the same tests. The additional popliteus muscle load significantly reduced the in situ forces in the ligament by 9% to 36% at 90° and 30° of flexion, respectively. No significant effects on posterior tibial translation of the intact knee were found. However, in the ligament-deficient knee, posterior tibial translation was reduced by up to 36% of the translation caused by ligament transection. A coupled internal tibial rotation of 2° to 4° at 60° to 90° of knee flexion was observed in both the intact and ligament-deficient knees when the popliteus muscle load was added. Our results indicate that the popliteus muscle shares the function of the posterior cruciate ligament in resisting posterior tibial loads and can contribute to knee stability when the ligament is absent.

scholarly journals Avulsion of the Femoral Attachment of the Medial Collateral Ligament of the Knee Associated to Complete Tear of the Posterior Cruciate Ligament: A Case Report

2017 ◽  
Vol 03 (01) ◽  
pp. e38-e41 ◽  
Author(s):  
Sleiman Haddad ◽  
Andrea Sallent ◽  
Joan Minguell ◽  
Enric Castellet
Keyword(s):  
Posterior Cruciate Ligament ◽  
Medial Collateral Ligament ◽  
Cruciate Ligament ◽  
Double Bundle ◽  
Return To Play ◽  
Surgical Reconstruction ◽  
Collateral Ligament ◽  
Complete Tear ◽  
Flexion Extension ◽  
Femoral Avulsion

AbstractMedial collateral ligament (MCL) of the knee is one of the most commonly injured ligaments of the knee. Incidence of posterior cruciate ligament (PCL) injuries can vary widely. Conservative treatment has shown good clinical outcomes and relatively rapid return to play in both injuries alone. We present the case of a 38-year-old male who presented a combined MCL avulsion injury and PCL tear treated surgically. The PCL was reconstructed using the double-bundle Achilles allograft technique. Within the same surgery, a medial femoral incision was performed to reinsert the avulsion of the bone fragment rotated and distally retracted together with the MCL with bone anchors and Spike Washer. Two years after surgery, the patient enjoyed a 0/140-degree range of motion for flexion/extension. He had returned to sports and was pain-free. In conclusion, femoral avulsion of the MCL associated to PCL injury is a rare and nondescribed injury that, as opposed to most MCL isolated injuries, might benefit from early surgical reconstruction.

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