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

2021 ◽  
Vol 29 (2) ◽  
pp. 230949902110215
Author(s):  
Tsuneari Takahashi ◽  
Katsushi Takeshita
Keyword(s):  
Medial Collateral Ligament ◽  
Maximum Load ◽  
Large Animal ◽  
Suture Anchors ◽  
Collateral Ligament ◽  
Yield Load ◽  
Femoral Attachment ◽  
Medial Collateral Ligament Injury ◽  
Superficial Medial Collateral Ligament ◽  
Grade 3

Purpose: To clarify the biomechanical and radiological outcomes of superficial medial collateral ligament (sMCL) repair using suture anchors in a large animal model. Methods: The right sMCLs of nine male castrated pigs was completely detached at the femoral attachment. sMCL repair surgery was performed using two suture anchors. The same skin incision, sMCL exposure, and immediate wound closure were made at the left knee as a sham surgery. Magnetic resonance imaging was performed preoperatively and 4 weeks after surgery. The structural properties (upper yield load, maximum load, linear stiffness, and elongation at failure) of the femur-sMCL-tibia complex were determined. Results: During tensile testing, all the repaired sMCLs avulsed from the femoral attachment. There were no significant differences in the upper yield load, maximum load, linear stiffness, or elongation at failure between the groups 4 weeks after surgery or in the MRI-derived signal-to-noise quotients (SNQs) at the mid and tibial sMCL. The SNQs differed significantly at the femoral (2.7 ± 1.2 vs 0.3 ± 0.7; P = 0.00064) portions between groups. Conclusion: The injured sMCLs biomechanically recovered after surgery using suture anchors even though the SNQs were higher than those with native contralateral sMCLs. For clinical relevance, sMCL repair of grade 3 sMCL injuries using suture anchors was both safe and successful with less tissue dissection.

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.

Acute Grade III Medial Collateral Ligament Injury of the Knee Associated with Anterior Cruciate Ligament Tear: The Usefulness of Magnetic Resonance Imaging in Determining a Treatment Regimen

2003 ◽  
Vol 31 (2) ◽  
pp. 261-267 ◽  
Author(s):  
Norimasa Nakamura ◽  
Shuji Horibe ◽  
Yukiyoshi Toritsuka ◽  
Tomoki Mitsuoka ◽  
Hideki Yoshikawa ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Medial Collateral Ligament ◽  
Cruciate Ligament ◽  
Superficial Layer ◽  
Ligament Injury ◽  
Resonance Imaging ◽  
Collateral Ligament ◽  
Medial Collateral Ligament Injury ◽  
Anterior Cruciate ◽  
Grade Iii

Background: The appropriate management of acute grade III medial collateral ligament injury when it is combined with a torn anterior cruciate ligament has not been determined. Hypothesis: Magnetic resonance imaging grading of grade III medial collateral ligament injury in patients who also have anterior cruciate ligament injury correlates with the outcome of their nonoperative treatment. Study Design: Prospective cohort study. Methods: Seventeen patients were first treated nonoperatively with bracing. Eleven patients with restored valgus stability received anterior cruciate ligament reconstruction only, and six with residual valgus laxity also received medial collateral ligament surgery. Results: Magnetic resonance imaging depicted complete disruption of the superficial layer of the medial collateral ligament in all 17 patients and disruption of the deep layer in 14. Restoration of valgus stability was significantly correlated with the location of superficial fiber damage. Damage was evident over the whole length of the superficial layer in five patients, and all five patients had residual valgus laxity despite bracing. Both groups had good-to-excellent results 5 years later. Conclusions: Location of injury in the superficial layer may be useful in predicting the outcome of nonoperative treatment for acute grade III medial collateral ligament lesions combined with anterior cruciate ligament injury.

scholarly journals Percutaneous Superficial Medial Collateral Ligament Release Outcomes During Medial Meniscal Arthroscopy: A Systematic Review

2020 ◽  
Vol 2 (2) ◽  
pp. e153-e159
Author(s):  
Michael A. Gaudiani ◽  
Derrick M. Knapik ◽  
Matthew W. Kaufman ◽  
Michael J. Salata ◽  
James E. Voos ◽  
...  
Keyword(s):  
Systematic Review ◽  
Medial Collateral Ligament ◽  
Collateral Ligament ◽  
Superficial Medial Collateral Ligament
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