scholarly journals A novel Medial Patellofemoral Ligament Reconstruction Technique; Preliminary Clinical Results

2017 ◽  
Vol 5 (2_suppl2) ◽  
pp. 2325967117S0007
Author(s):  
Hasan Basri Sezer ◽  
Raffi Armağan ◽  
Muharrem Kanar ◽  
Osman Tuğrul Eren
Keyword(s):  
Range Of Motion ◽  
Medial Patellofemoral Ligament ◽  
Femoral Tunnel ◽  
Full Range ◽  
Lateral Collateral Ligament ◽  
Reconstruction Technique ◽  
Collateral Ligament ◽  
Ligament Rupture ◽  
Patella Luxation ◽  
The Mean

Medial Patellofemoral ligament(MPFL) is the main passive stabilizer of the patellofemoral joint. MPFL is injured in the 2/3 rds of the patients after patella luxation. In this study we present a novel aproach to the anatomical MPFL reconstruction and preliminary results of the technique. We operated 7 patients(4 female and female and 3 male) who applied to our clinic after a patella luxation episode. The mean age was 27,1 years(16-42). The mean follow up time was 23,5 months(24-35). We evaluated the patients clinically and radiologically for concommitant pathologies. 1 patient had patellar cartilage demage and patella alta, 1 patient had medial collateral ligament rupture, 1 patient had lateral collateral ligament and anterior cruciate ligament rupture and these pathologies were treated as well. The operation was done in the supine position on a radiolucent table and under the image intensifier control. The semitendinosus autograft was prepared. The femoral tunnel was drilled and double strand graft was introduced in the femoral tunnel and secured with ToggleLoc femoral fixation device(Biomet). The graft was advanced over the facia to the patellar side and passed through the 2 patellar tunnels and tied to each other. After exercising the knee the graft tension was rechecked at 30 degrees of knee flexion. Early postoperatively range of motion and quadriceps strenghtening exercises were carried out and patients were allowed to bear weight. All of the patients had full range of motion and free of pain. Postoperative x-ray and MRI examinations revealed the correction of patellar tilt and lateral shift of the patella in all patients. The only complication was a fissure of patella in 1 patient in the 6th week of rehabilitation due to anteriorly located patellar tunnel and heavy exercise. We immobilsed the patient in a brace and the patient returned to rehabilitation after 6 weeks when the fissure healed. All the patients returned to the previous functional level. Our anatomical MPFL technique uses ToggleLoc for the femoral side but implant free at the patellar side. The technique provided excellent preliminiary result in all of the patients. The technique allows graft retensioning again and again from both the femoral and the patellar side. The double bundle reconstruction seems to immitate the natural behaviour of the MPFL. However patellar tunnels carry a substantial risk of patella fracture and must be placed with great attention.

scholarly journals Medial Patellofemoral Ligament Reconstruction Femoral Tunnel Accuracy

2017 ◽  
Vol 5 (2) ◽  
pp. 232596711668774 ◽  
Author(s):  
Laurie A. Hiemstra ◽  
Sarah Kerslake ◽  
Mark Lafave
Keyword(s):  
Quality Of Life ◽  
Medial Patellofemoral Ligament ◽  
Femoral Tunnel ◽  
Patellofemoral Instability ◽  
Mpfl Reconstruction ◽  
Tunnel Position ◽  
Femoral Tunnel Position ◽  
The Mean ◽  
Femoral Tunnel Placement

Background: Medial patellofemoral ligament (MPFL) reconstruction is a procedure aimed to reestablish the checkrein to lateral patellar translation in patients with symptomatic patellofemoral instability. Correct femoral tunnel position is thought to be crucial to successful MPFL reconstruction, but the accuracy of this statement in terms of patient outcomes has not been tested. Purpose: To assess the accuracy of femoral tunnel placement in an MPFL reconstruction cohort and to determine the correlation between tunnel accuracy and a validated disease-specific, patient-reported quality-of-life outcome measure. Study Design: Case series; Level of evidence, 4. Methods: Between June 2008 and February 2014, a total of 206 subjects underwent an MPFL reconstruction. Lateral radiographs were measured to determine the accuracy of the femoral tunnel by measuring the distance from the center of the femoral tunnel to the Schöttle point. Banff Patella Instability Instrument (BPII) scores were collected a mean 24 months postoperatively. Results: A total of 155 (79.5%) subjects had adequate postoperative lateral radiographs and complete BPII scores. The mean duration of follow-up (±SD) was 24.4 ± 8.2 months (range, 12-74 months). Measurement from the center of the femoral tunnel to the Schöttle point resulted in 143 (92.3%) tunnels being categorized as “good” or “ideal.” There were 8 failures in the cohort, none of which occurred in malpositioned tunnels. The mean distance from the center of the MPFL tunnel to the center of the Schöttle point was 5.9 ± 4.2 mm (range, 0.5-25.9 mm). The mean postoperative BPII score was 65.2 ± 22.5 (range, 9.2-100). Pearson r correlation demonstrated no statistically significant relationship between accuracy of femoral tunnel position and BPII score ( r = –0.08; 95% CI, –0.24 to 0.08). Conclusion: There was no evidence of a correlation between the accuracy of MPFL reconstruction femoral tunnel in relation to the Schöttle point and disease-specific quality-of-life scores. Graft failure was not related to femoral tunnel placement. The patellofemoral instability population is complex, and patients present with multiple risk factors that, in addition to the accuracy of femoral tunnel position, contribute to quality of life and warrant further investigation.

The role of the posterior bundle of the medial collateral ligament in posteromedial rotatory instability of the elbow

2018 ◽  
Vol 100-B (8) ◽  
pp. 1060-1065 ◽  
Author(s):  
J-T. Hwang ◽  
M. N. Shields ◽  
L. J. Berglund ◽  
A. W. Hooke ◽  
J. S. Fitzsimmons ◽  
...  
Keyword(s):  
Contact Pressure ◽  
Medial Collateral Ligament ◽  
Lateral Collateral Ligament ◽  
Collateral Ligament ◽  
Coronoid Fracture ◽  
Rotatory Instability ◽  
Intact Group ◽  
Joint Contact ◽  
The Mean ◽  
Contact Pressures

Aims The aim of this study was to evaluate two hypotheses. First, that disruption of posterior bundle of the medial collateral ligament (PMCL) has to occur for the elbow to subluxate in cases of posteromedial rotatory instability (PMRI) and second, that ulnohumeral contact pressures increase after disruption of the PMCL. Materials and Methods Six human cadaveric elbows were prepared on a custom-designed apparatus which allowed muscle loading and passive elbow motion under gravitational varus. Joint contact pressures were measured sequentially in the intact elbow (INTACT), followed by an anteromedial subtype two coronoid fracture (COR), a lateral collateral ligament (LCL) tear (COR + LCL), and a PMCL tear (COR + LCL + PMCL). Results There was no subluxation or joint incongruity in the INTACT, COR, and COR + LCL specimens. All specimens in the COR + LCL + PMCL group subluxated under gravity-varus loads. The mean articular contact pressure of the COR + LCL group was significantly higher than those in the INTACT and the COR groups. The mean articular contact pressure of the COR + LCL + PMCL group was significantly higher than that of the INTACT group, but not higher than that of the COR + LCL group. Conclusion In the presence of an anteromedial fracture and disruption of the LCL, the posterior bundle of the MCL has to be disrupted for gross subluxation of the elbow to occur. However, elevated joint contact pressures are seen after an anteromedial fracture and LCL disruption even in the absence of such subluxation. Cite this article: Bone Joint J 2018;100-B:1060–5.

Valgus Instability of the Elbow Due to Medial Epicondyle Nonunion: Treatment by Fragment Excision and Medial Collateral Ligament Reconstruction

2017 ◽  
Vol 22 (01) ◽  
pp. 70-74 ◽  
Author(s):  
Yasunori Kaneshiro ◽  
Noriaki Hidaka ◽  
Koichi Yano ◽  
Makoto Fukuda ◽  
Hideki Sakanaka
Keyword(s):  
Range Of Motion ◽  
Medial Collateral Ligament ◽  
Ligament Reconstruction ◽  
Signs And Symptoms ◽  
Medial Epicondyle ◽  
Collateral Ligament ◽  
Valgus Instability ◽  
Bone Fragments ◽  
The Mean ◽  
Fragment Excision

Background: The medial epicondyle nonunion becomes symptomatic valgus instability with medial elbow pain and joint instability due to dysfunction of the medial collateral ligament (MCL), thus requiring surgical treatment. The purpose of the present study is to report the clinical result of the fragment excision and ligament reconstruction by free tendon graft in the treatment of symptomatic medial epicondyle nonunion. Methods: A retrospective study of five consecutive patients was performed. All five patients had signs and symptoms of valgus instability of the elbow. The mean period of nonunion was 25 years, and their injuries progressed asymptomatically until symptoms developed in adulthood after a second injury. Results: All patients were treated by fragment excision and MCL reconstruction. At the final follow-up, no patients exhibited pain or instability. The mean joint range of motion was 0o of extension and 138o of flexion, with an MEPS of 100 points in all patients. Conclusions: By ligament reconstruction for MCL insufficiency and removing the bone fragments avoided irritation by the bone fragments, pain and instability disappeared, good range of motion was restored, and excellent outcomes were achieved in all patients. We believe that fragment excision and MCL reconstruction should be considered as the treatment option for symptomatic medial epicondyle nonunion of the humerus.

scholarly journals Use of Suture Anchors for Coronoid Fractures in the Terrible Triad of the Elbow

2009 ◽  
Vol 17 (1) ◽  
pp. 31-35 ◽  
Author(s):  
V Pai ◽  
V Pai
Keyword(s):  
Radial Head ◽  
Lateral Collateral Ligament ◽  
Lateral Condyle ◽  
Type I ◽  
Suture Anchors ◽  
Terrible Triad ◽  
Collateral Ligament ◽  
Range Of Movement ◽  
Flexion Extension ◽  
The Mean

Purpose. To report outcomes in 6 patients with the terrible triad of the elbow treated with our modified protocol. Methods. 6 men aged 26 to 54 years underwent surgery for the terrible triad of the elbow by a single surgeon. All the patients had a displaced comminuted fracture of the radius, posterior dislocation of the elbow, and Morrey type-I fracture of the coronoid. They all underwent replacement of the radial head and repair of the lateral collateral ligament to the isometric part of the lateral condyle using suture anchors. Five had an additional capsular fixation to the anterior coronoid using suture anchors; in patient 6 the coronoid was not repaired because it was stable. Functional outcomes were evaluated using the Hospital for Special Surgery (HSS) elbow assessment score. Bone union, implant loosening, heterotopic ossification, and degenerative changes were assessed using anteroposterior and lateral radiographs. Results. After a mean follow-up of 2.2 (range, 1–3) years, the mean arc of flexion-extension was 116 degrees and the mean flexion contracture was 15 degrees. All patients maintained a concentric reduction of both the ulnotrochlear and the radiocapitellar articulation, with isometric fixation of the lateral collateral ligament. No patient had dislocation of the radial-head prosthesis. All had good-to-excellent HSS elbow scores, and none required re-operation. Patient 2 had neuropraxia of the radial nerve, which recovered within 3 months. Patient 4 had a range of movement of only 20 to 100 degrees, but was satisfied with the outcome. Conclusion. Repair of the articular capsule using suture anchors in addition to replacement of the radial head and repair of the lateral collateral ligament achieves favourable outcome in patients with the terible triad of the elbow.

scholarly journals Magnetic resonance imaging comparison of lateral collateral ligament and patellar tendon length

2014 ◽  
Vol 67 (7-8) ◽  
pp. 197-201
Author(s):  
Vesna Njagulj ◽  
Nemanja Kovacev ◽  
Predrag Rasovic ◽  
Robert Semnic ◽  
Miroslav Milankov
Keyword(s):  
Magnetic Resonance Imaging ◽  
Patellar Tendon ◽  
Ligament Reconstruction ◽  
Lateral Collateral Ligament ◽  
Resonance Imaging ◽  
Collateral Ligament ◽  
Tendon Length ◽  
Significant Difference ◽  
Patellar Tendon Length ◽  
The Mean

Introduction. The problem of using patellar tendon auto or allografts for lateral collateral ligament reconstruction results in the occurrence of ligaments mismatch. The length of patellar tendon does not match the lateral collateral ligament. Material and Methods. Out of 151 patients, who formed the study, 102 were men with the mean age of 30 years (18-54) and 49 women, with the mean age of 34 (18-55), and they all underwent magnetic resonance imaging of the knee. Both patellar tendon and lateral collateral ligament were measured using a three-dimensional isovoxel truefast-imaging with steady-state precession sequence with water excitation and secondary multiplanar reformations. In order to visualize the lateral collateral ligament insertions precisely, sagittal images were reformatted according to the anatomical, oblique ligament position, in anteriorly tilted, paracoronal plane. The length of the patellar tendon was measured from the patellar apex to the tibial tuberosity insertion site. Results. The mean patellar tendon length was 52.88?7.56 mm (37-75) with a significant difference between men and women. The mean lateral collateral ligament length was 61.21?5.77 mm (46-80) with a significant difference between genders. The average differences between lateral collateral ligament and patellar tendon length was 8.38?7.23 mm (-9 to 26) without a significant difference between the genders. In 18 (11.92%) patients, the patellar tendon was longer than the lateral collateral ligament; in 7 patients (4.63%) they were equal; and in 126 patients (83.44%) the patellar tendon was shorter than the lateral collateral ligament. Conclusion. The length of patellar tendon does not match the length of lateral collateral ligament. If patellar tendon auto or allograft is used for lateral collateral ligament reconstruction, the lengths of both ligaments must be determined preoperatively in order to avoid intraoperative complications.

Ligamentous repair of acute lateral collateral ligament rupture of the elbow

2013 ◽  
Vol 22 (11) ◽  
pp. 1469-1473 ◽  
Author(s):  
Byung Sung Kim ◽  
Kang Hee Park ◽  
Hyun Seok Song ◽  
Sung-Yong Park
Keyword(s):  
Lateral Collateral Ligament ◽  
Collateral Ligament ◽  
Ligament Rupture ◽  
Ligamentous Repair

Surgical management of traumatic elbow luxation in two cats using circumferential suture prostheses

2009 ◽  
Vol 22 (01) ◽  
pp. 66-69 ◽  
Author(s):  
D. G. Thomson ◽  
S. Carmichael ◽  
M. Farrell
Keyword(s):  
Postoperative Complications ◽  
Range Of Motion ◽  
Surgical Management ◽  
Lateral Collateral Ligament ◽  
The Other ◽  
Collateral Ligament ◽  
Elbow Luxation ◽  
Lateral Elbow

SummaryTwo Domestic Shorthaired cats were admitted after sustaining a traumatic lateral elbow luxation. Non-surgical management with reduction and external coaptation was unsuccessful at maintaining reduction. At surgery, the lateral collateral ligament (LCL) was intact but grossly elongated in one case, and ruptured in the other. Trans-condylar, trans-radial and trans-ulnar tunnels were drilled from lateral to medial and a suture prosthesis was used in order to augment a suture imbrication of the LCL in the fist cat. The prosthesis was used as a stand-alone procedure in the second case. No postoperative complications occurred and both patients regained excellent elbow range of motion without any observable lameness.

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