scholarly journals Internal and External Rotation Stabilizers of the Knee with Intact Cruciate and Collateral Ligaments

2017 ◽  
Vol 5 (3_suppl3) ◽  
pp. 2325967117S0012
Author(s):  
Alexander R. Vap ◽  
Jason M. Schon ◽  
Gilbert Moatshe ◽  
Raphael Cruz ◽  
Alex Brady ◽  
...  
Keyword(s):  
Internal Rotation ◽  
Knee Flexion ◽  
External Rotation ◽  
Iliotibial Band ◽  
Popliteus Tendon ◽  
Primary Role ◽  
Collateral Ligaments ◽  
Popliteofibular Ligament ◽  
Full Extension ◽  
Text Figure

Objectives: The purpose of this study was to assess the effect of sequentially cutting the posterolateral, anterolateral, posteromedial and anteromedial structures of the knee on rotational kinematics in the setting of intact cruciate and collateral ligaments. It was hypothesized that cutting of the iliotibial band (ITB), anterolateral ligament and lateral capsule (ALL/LC), the posterior oblique ligament (POL), and the posteromedial capsule (PMC) would significantly increase internal rotation and that the anteromedial capsule (AMC), and the popliteus tendon and popliteofibular ligament (PLT/PFL) when sectioned would lead to a significant increase in external rotation of the knee. Methods: Ten pairs ( n = 20) of cadaveric knees were assigned to two sequential cutting groups (posterolateral-to-posteromedial and posteromedial-to-posterolateral). Specimen were subjected to 5 N-m of internal and external rotation torque at knee flexion angles 0° through 90° in the intact and after each cut state. Rotational changes were measured and compared to the intact and previous states following each cut. Results: Sectioning of the ITB significantly increased internal rotation at 60° and 90° by 5.4° and 6.2[[Unsupported Character - Codename ­]]°, respectively (after ALL/LC cut) and 3.5° and 3.8° (prior to ALL/LC cut) ( Figure 1 ). At 60° and 90°, section of the ALL/LC produced significant increases in internal rotation of 3.1[[Unsupported Character - Codename ­]]° and 3.5°, respectively (after ITB cut) and of 0.5° (prior to ITB cut) ( Figure 1 ). At 0°, section of the POL produced significant increases in internal rotation of 2.0° (ITB intact) and 1.8° (after ITB cut) ( Figure 1 ). Sectioning the PLT/PFL complex significantly increased external rotation at 60° and 90° by 2.7° and 2.9°, respectively (prior to sectioning medial structures) and 2.2° and 2.7[[Unsupported Character - Codename ­]]°, respectively (after sectioning medial structures) ( Figure 2 ). Sectioning the AMC produced significant increases in external rotation at 30°- 90° of flexion, however the magnitude of change was < 1° ( Figure 2 ). [Figure: see text][Figure: see text] Conclusion: Collectively the anterolateral corner structures had a primary role in internal rotational control of the knee from 60° to 90° of knee flexion. The ITB was the most significant primary stabilizer for internal rotation in ACL intact knees. The POL contributed to internal rotational control at full extension, while the PLT/PFL complex controlled external rotation of the knee at higher flexion angles (60° and 90°). Internal rotation control of the knee has been mainly attributed to the cruciate and collateral ligaments. This study delineates the primary and secondary roles of the ITB, the ALL/LC, POL and PLT/PFL to rotatory stability of the knee. As such, it provides new information about the understanding of rotational instabilities of the knee.

scholarly journals The Role of the Peripheral Passive Rotation Stabilizers of the Knee With Intact Collateral and Cruciate Ligaments: A Biomechanical Study

2017 ◽  
Vol 5 (5) ◽  
pp. 232596711770819 ◽  
Author(s):  
Alexander R. Vap ◽  
Jason M. Schon ◽  
Gilbert Moatshe ◽  
Raphael S. Cruz ◽  
Alex W. Brady ◽  
...  
Keyword(s):  
Internal Rotation ◽  
Knee Flexion ◽  
External Rotation ◽  
Rotational Stability ◽  
Iliotibial Band ◽  
Popliteus Tendon ◽  
Primary Role ◽  
Collateral Ligaments ◽  
Group 2 ◽  
Group 1

Background: A subset of patients have clinical internal and/or external knee rotational instability despite no apparent injury to the cruciate or collateral ligaments. Purpose/Hypothesis: The purpose of this study was to assess the effect of sequentially cutting the posterolateral, anterolateral, posteromedial, and anteromedial structures of the knee on rotational stability in the setting of intact cruciate and collateral ligaments. It was hypothesized that cutting of the iliotibial band (ITB), anterolateral ligament and lateral capsule (ALL/LC), posterior oblique ligament (POL), and posteromedial capsule (PMC) would significantly increase internal rotation, while sectioning of the anteromedial capsule (AMC) and the popliteus tendon and popliteofibular ligament (PLT/PFL) would lead to a significant increase in external knee rotation. Study Design: Controlled laboratory study. Methods: Ten pairs (N = 20) of cadaveric knees were assigned to 2 sequential cutting groups (group 1: posterolateral-to-posteromedial [PL → PM] and group 2: posteromedial-to-posterolateral [PM → PL]). Specimens were subjected to applied 5-N·m internal and external rotation torques at knee flexion angles of 0°, 30°, 60°, and 90° while intact and after each cut state. Rotational changes were measured and compared with the intact and previous cut states. Results: Sectioning of the ITB significantly increased internal rotation at 60° and 90° by 5.4° and 6.2° in group 1 (PL → PM) and 3.5° and 3.8° in group 2 (PM → PL). PLT/PFL complex sectioning significantly increased external rotation at 60° and 90° by 2.7° and 2.9° in group 1 (PL → PM). At 60° and 90° in group 2 (PM → PL), ALL/LC sectioning produced significant increases in internal rotation of 3.1° and 3.5°, respectively. In group 2 (PM → PL), POL sectioning produced a significant increase in internal rotation of 2.0° at 0°. AMC sectioning significantly increased external rotation at 30° to 90° of flexion with a magnitude of change of <1° in both groups 1 (PL → PM) and 2 (PM → PL). Conclusion: Collectively, the anterolateral corner structures provided primary internal rotation control of the knee from 60° to 90° of knee flexion in knees with intact cruciate and collateral ligaments. The ITB was the most significant primary stabilizer of internal rotation. The POL had a primary role for internal rotational stability at full extension. The PLT/PFL complex was a primary stabilizer for external rotation of the knee at 60° and 90°. Clinical Relevance: This study delineates the primary and secondary roles of the ITB, ALL/LC, POL, and PLT/PFL to rotatory stability of the knee and provides new information to understand knee rotational instabilities.

Biomechanical Analysis of an Isolated Fibular (Lateral) Collateral Ligament Reconstruction Using an Autogenous Semitendinosus Graft

2007 ◽  
Vol 35 (9) ◽  
pp. 1521-1527 ◽  
Author(s):  
Benjamin R. Coobs ◽  
Robert F. LaPrade ◽  
Chad J. Griffith ◽  
Bradley J. Nelson
Keyword(s):  
Internal Rotation ◽  
Knee Flexion ◽  
Ligament Reconstruction ◽  
External Rotation ◽  
Anatomic Reconstruction ◽  
Ligament Injury ◽  
Collateral Ligament ◽  
Fibular Collateral Ligament ◽  
Normal Stability ◽  
Semitendinosus Graft

Background The fibular collateral ligament is the primary stabilizer to varus instability of the knee. Untreated fibular collateral ligament injuries can lead to residual knee instability and can increase the risk of concurrent cruciate ligament reconstruction graft failures. Anatomic reconstructions of the fibular collateral ligament have not been biomechanically validated. Purpose To describe an anatomic fibular collateral ligament reconstruction using an autogenous semitendinosus graft and to test the hypothesis that using this reconstruction technique to treat an isolated fibular collateral ligament injury will restore the knee to near normal stability. Study Design Controlled laboratory study. Methods Ten nonpaired, fresh-frozen cadaveric knees were biomechanically subjected to a 10 N·m varus moment and 5 N·m external and internal rotation torques at 0°, 15°, 30°, 60°, and 90° of knee flexion. Testing was performed with an intact and sectioned fibular collateral ligament, and also after an anatomic reconstruction of the fibular collateral ligament with an autogenous semitendinosus graft. Motion changes were assessed with a 6 degree of freedom electromagnetic motion analysis system. Results After sectioning, we found significant increases in varus rotation at 0°, 15°, 30°, 60°, and 90°, external rotation at 60° and 90°, and internal rotation at 0°, 15°, 30°, 60°, and 90° of knee flexion. After reconstruction, there were significant decreases in motion in varus rotation at 0°, 15°, 30°, 60°, and 90°, external rotation at 60° and 90°, and internal rotation at 0°, 15°, and 30° of knee flexion. In addition, we observed a full recovery of knee stability in varus rotation at 0°, 60°, and 90°, external rotation at 60° and 90°, and internal rotation at 0° and 30° of knee flexion. Conclusion An anatomic fibular collateral ligament reconstruction restores varus, external, and internal rotation to near normal stability in a knee with an isolated fibular collateral ligament injury. Clinical Significance An anatomic reconstruction of the fibular collateral ligament with an autogenous semitendinosus graft is a viable option to treat nonrepairable acute or chronic fibular collateral ligament tears in patients with varus instability.

Anatomic and Histological Investigation of the Anterolateral Capsular Complex in the Fetal Knee

2017 ◽  
Vol 45 (6) ◽  
pp. 1383-1387 ◽  
Author(s):  
Soheil Sabzevari ◽  
Amir Ata Rahnemai-Azar ◽  
Marcio Albers ◽  
Monica Linde ◽  
Patrick Smolinski ◽  
...  
Keyword(s):  
Gestational Age ◽  
Histological Analysis ◽  
External Rotation ◽  
Lower Limbs ◽  
Iliotibial Band ◽  
Popliteus Tendon ◽  
Superficial Fascia ◽  
Anterolateral Complex ◽  
Anterolateral Capsule ◽  
Ligamentous Structure

Background: There is currently disagreement with regard to the presence of a distinct ligament in the anterolateral capsular complex of the knee and its role in the pivot-shift mechanism and rotatory laxity of the knee. Purpose: To investigate the anatomic and histological properties of the anterolateral capsular complex of the fetal knee to determine whether there exists a distinct ligamentous structure running from the lateral femoral epicondyle inserting into the anterolateral tibia. Study Design: Descriptive laboratory study. Methods: Twenty-one unpaired, fresh fetal lower limbs, gestational age 18 to 22 weeks, were used for anatomic investigation. Two experienced orthopaedic surgeons performed the anatomic dissection using loupes (magnification ×3.5). Attention was focused on the anterolateral and lateral structures of the knee. After the skin and superficial fascia were removed, the iliotibial band was carefully separated from underlying structures. The anterolateral capsule was then examined under internal and external rotation and varus-valgus manual loading and at different knee flexion angles for the presence of any ligamentous structures. Eight additional unpaired, fetal lower limbs, gestational age 11 to 23 weeks, were used for histological analysis. Results: This study was not able to prove the presence of a distinct capsular or extracapsular ligamentous structure in the anterolateral capsular complex area. The presence of the fibular collateral ligament, a distal attachment of the biceps femoris, the entire lateral capsule, the iliotibial band, and the popliteus tendon in the anterolateral and lateral area of the knee was confirmed in all the samples. Histological analysis of the anterolateral capsule revealed a loose, hypocellular connective tissue with less organized collagen fibers compared with ligament and tendinous structures. Conclusion: The main finding of this study was that the presence of a distinct ligamentous structure in the anterolateral complex is not supported from a developmental point of view, while all other anatomic structures were present. Clinical Relevance: The inability to prove the existence of a distinct ligamentous structure, called the anterolateral ligament, in the anterolateral knee capsule may indicate that the other components of the anterolateral complex, such as the lateral capsule, the iliotibial band, and its capsule-osseous layer, are more important for knee rotatory stability.

scholarly journals Sequential Damage Assessment of the Posterolateral Complex of the Knee Joint: A Finite Element Study

2021 ◽  
Author(s):  
Cong-Cong Wu ◽  
Li-Mei Ye ◽  
Xiao-fei Li ◽  
Lin-Jun Shi
Keyword(s):  
Finite Element ◽  
Knee Joint ◽  
External Rotation ◽  
Lateral Collateral Ligament ◽  
Fe Model ◽  
Popliteus Tendon ◽  
Popliteofibular Ligament ◽  
Instantaneous Axis Of Rotation ◽  
Property Data ◽  
Posterolateral Complex

Abstract Background. The posterolateral complex (PLC), which consists of the popliteus tendon (PT), lateral collateral ligament (LCL), and popliteofibular ligament (PFL), is an indispensable structure of the knee joint. The aim of this study was to explore the functionality of the PLC by determining the specific role of each component in maintaining posterolateral knee stability. Methods. A finite element (FE) model was generated based on previous material property data and magnetic resonance imaging of a volunteer’s knee joint. The injury order of the PLC was set as LCL, PFL, and PT. A 134 N anterior load was applied to the tibia to investigate tibial displacement (TD). Tibial external rotation (TER) and tibial varus angulation (TVA) were measured under bending motions of 5 and 10 Nm. The instantaneous axis of rotation (IAR) of the knee joint under different rotation motions was also recorded. Results. The TD of the intact knee under a 134 N anterior load matched the values determined in previous studies. Our model showed consistent increases in TD, TVA, and TER after sequential damage of the PLC. In addition, sequential disruption caused the IAR to shift superiorly and laterally during varus rotation, and medially and anteriorly during external rotation. In the dynamic damage of the PLC, LCL injury had the largest effect on TD, TVA, TER, and IAR. Conclusions. Sequential injury of the PLC caused considerable loss of stability of the knee joint according to an FE model. The most significant structure of the PLC was the LCL.

scholarly journals Kinematics of the posterolateral corner of the knee: A human cadaveric cutting study.

2017 ◽  
Vol 5 (4_suppl4) ◽  
pp. 2325967117S0013
Author(s):  
Tobias Drenck ◽  
Christoph Domnick ◽  
Mirco Herbort ◽  
Michael Raschke ◽  
Karl-Heinz Frosch
Keyword(s):  
Knee Flexion ◽  
External Rotation ◽  
Lateral Collateral Ligament ◽  
Posterolateral Corner ◽  
Clinical Diagnostics ◽  
Popliteus Tendon ◽  
Collateral Ligament ◽  
Intact State ◽  
Posterior Tibial ◽  
Intact Knee

Aims and Objectives: The posterolateral corner of the knee consists of different structures, which contribute to instability when damaged after injury or within surgery. Knowing the kinematic influences may help to improve clinical diagnostics and surgical techniques. The purpose was to determine static stabilizing effects of the posterolateral corner by dissecting stepwise all fibers and ligaments (the arcuat complex, AC) connected with the popliteus tendon (PLT) and the influence on lateral stability in the lateral collateral ligament (LCL) intact-state. Materials ans Methods: Kinematics were examined in 13 fresh-frozen human cadaveric knees using a robotic/UFS testing system with an optical tracking system. The knee kinematics were determined for 134 N anterior/posterior loads, 10 Nm valgus/varus loads and 5 Nm internal/external rotational loads in 0°, 20°, 30°, 60° and 90° of knee flexion. The posterolateral corner structures were consecutively dissected: The I.) intact knee joint, II.) with dissected posterior cruciate ligament, III.) meniscofibular/-tibial fibers, IV.) popliteofibular ligament, V.) popliteotibial fascicle (last structure of static AC), VI.) PLT and VII.) LCL. Results: The external rotation angle increased significantly by 2.6° to 7.9° (P<.05) in 0° to 90° of knee flexion and posterior tibial translation increased by 2.9 mm to 5.9 mm in 20° to 90° of knee flexion (P<.05) after cutting the AC/PLT structures (with intact LCL) in contrast to the PCL deficient knee. Differences between dissected static AC and dissected PLT were only found in 60° and 90° external rotation tests (by 2.1° and 3.1°; P<.05). In the other 28 kinematic tests, no significant differences between PLT and AC were found. Cutting the AC/PLT complex did not further decrease varus, valgus or anterior tibial stability in any flexion angle in comparison to the PCL dissected state. Conclusion: The arcuat complex is an important static stabilizer for external rotatory and posterior tibial loads of the knee, even in the lateral collateral ligament intact-state. After dissecting the major parts of the arcuat complex, the static stabilizing function of the popliteus tendon is lost. The arcuat complex has no varus-stabilizing function in the LCL-intact knee. The anatomy and function of these structures for external-rotational and posterior-translational stabilization should be considered for clinical diagnostics and when performing surgery in the posterolateral corner.

Comparison of Lower Extremity Muscle Flexibility in Amateur and Trained Bharatanatyam Dancers and Nondancers

2018 ◽  
Vol 33 (1) ◽  
pp. 20-25
Author(s):  
Monica Sharma ◽  
Shibili Nuhmani ◽  
Deepti Wardhan ◽  
Qassim I Muaidi
Keyword(s):  
Internal Rotation ◽  
Lower Limb ◽  
Knee Flexion ◽  
External Rotation ◽  
Lower Limb Muscle ◽  
Limb Muscle ◽  
Lower Extremity Muscle ◽  
Significant Difference ◽  
Flexion Extension ◽  
Hip Flexion

OBJECTIVE: This study compared lower limb muscle flexibility between amateur and trained female Bharatanatyam dancers and nondancers. METHODS: Subjects consisted of 105 healthy female volunteers, with 70 female Bharatanatyam dancers (35 trained, 35 amateurs) and 35 controls, with a mean (±SD) age of 16.2±1.04 yrs, height 155.05±4.30 cm, and weight 54.54±2.77 kg. Participants were assessed for range of motion (ROM) in hip flexion, hip extension, hip abduction and adduction, hip external rotation, hip internal rotation, knee flexion, knee extension, ankle dorsiflexion (DF), and ankle plantar flexion (PF) by using a standardized goniometer. To assess for significant difference between groups, one-way ANOVA was applied, and multiple comparisons were made using Bonferroni correction. RESULTS: Trained dancers had a significantly greater hip flexion, extension, abduction, and external rotation ROM than amateurs and nondancers (p<0.05). Also, internal rotation and adduction were markedly less in trained dancers (p<0.05). Knee flexion, extension, and ankle DF were higher and ankle PF ROM was lesser in trained dancers. However, not much variation was found in ankle DF and PF between amateur dancers and nondancers (p>0.05). CONCLUSION: Results showed that there are significant differences in lower limb muscle flexibility between trained and amateur Bharatanatyam dancers and nondancers. These differences may be due to individual dance postures such as araimandi and muzhumandi.

scholarly journals EFFECT OF STATIC ANATOMIC ALIGNMENT ON DYNAMIC LIMB VALGUS DURING SIDE-STEP CUTTING IN UNINJURED ADOLESCENT ATHLETES

2019 ◽  
Vol 7 (3_suppl) ◽  
pp. 2325967119S0002
Author(s):  
Nicole Mueske ◽  
Daniel T. Feifer ◽  
Curtis VandenBerg ◽  
J. Lee Pace ◽  
Mia J. Katzel ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Internal Rotation ◽  
Knee Flexion ◽  
External Rotation ◽  
Acl Injury ◽  
Adolescent Athletes ◽  
Knee Abduction ◽  
Hip Flexion ◽  
Hip Internal Rotation ◽  
Hip Rotation

BACKGROUND Dynamic limb valgus, combining hip adduction and internal rotation with knee abduction posture and moments, has been implicated in ACL injury. However, the contribution of static lower extremity alignment to dynamic limb valgus is unknown. This study assessed the relationships among lower extremity static alignment and dynamic kinematics and kinetics during side-step cutting in uninjured adolescent athletes. METHODS This prospective study included 88 limbs from 44 uninjured athletes aged 8-15 years (mean 12.3, SD 2.3; 19 (44%) female) who were evaluated during an anticipated 45° side-step cut. 3D lower extremity kinematics and kinetics from a custom 6 degree of freedom model were assessed while standing and during the loading phase of the cut from initial contact to peak knee flexion; 2-3 trials per limb were averaged for analysis. Femoral anteversion was measured for each limb with the participant lying prone. Relationships among static and dynamic measures were investigated using correlation and multiple linear regression. RESULTS In terms of static alignment, more static hip internal rotation and more static knee external rotation (tibia external relative to femur) were associated with more internal hip rotation and external knee rotation dynamically during cutting (r=0.34, p=0.001) (Table 1). Static hip adduction was also related to more external hip rotation and less hip flexion dynamically (p=0.24, p=0.02). More static knee abduction, external hip rotation and hip adduction were associated with higher average knee abduction angles during cutting (r=0.25, p=0.02). However, only static external knee rotation was associated with higher dynamic knee abduction moments (r=0.48, p<0.0001) (Figure 1). During cutting, positive associations were observed between hip flexion, knee flexion, and hip internal rotation (r=0.24, p=0.03). Knee adduction angles were related to more hip flexion, internal hip rotation, and knee external rotation (r=0.25, p=0.02). Additionally, lower peak knee flexion was associated with higher peak ground reaction force and more external knee rotation (r=0.24, p=0.02). Both simple correlation and multiple regression analysis indicated that higher knee abduction moments were related dynamically to higher knee abduction angles, greater knee external rotation, higher hip abduction angles, and greater hip internal rotation (R2=0.72, p<0.001). After considering dynamic metrics, no static measure remained significantly related to knee abduction moments. CONCLUSION/SIGNIFICANCE Static knee rotation was the only anatomic alignment measure associated with knee abduction moments during side-step cutting in uninjured adolescent athletes. Knee abduction moments were influenced more by dynamic posture than static alignment. As knee abduction moments have been implicated in ACL injury, this study supports the notion of dynamic limb valgus, specifically increased knee abduction and hip internal rotation, relating to ACL injury. Motion analysis can be used to identify these risky biomechanical patterns, and neuromuscular training can be used to correct them. Since knee abduction moments are primarily determined by dynamic posture, neuromuscular training can be used to reduce these moments and ACL injury risk. [Figure: see text][Table: see text]

scholarly journals Length-change patterns of the medial collateral ligament and posterior oblique ligament in relation to their function and surgery

2020 ◽  
Vol 28 (12) ◽  
pp. 3720-3732 ◽  
Author(s):  
Lukas Willinger ◽  
Shun Shinohara ◽  
Kiron K. Athwal ◽  
Simon Ball ◽  
Andy Williams ◽  
...  
Keyword(s):  
Internal Rotation ◽  
Medial Collateral Ligament ◽  
Knee Flexion ◽  
External Rotation ◽  
Length Change ◽  
Linear Displacement ◽  
Collateral Ligament ◽  
Posterior Oblique Ligament ◽  
Draw Force ◽  
Length Changes

Abstract Purpose To define the length-change patterns of the superficial medial collateral ligament (sMCL), deep MCL (dMCL), and posterior oblique ligament (POL) across knee flexion and with applied anterior and rotational loads, and to relate these findings to their functions in knee stability and to surgical repair or reconstruction. Methods Ten cadaveric knees were mounted in a kinematics rig with loaded quadriceps, ITB, and hamstrings. Length changes of the anterior and posterior fibres of the sMCL, dMCL, and POL were recorded from 0° to 100° flexion by use of a linear displacement transducer and normalised to lengths at 0° flexion. Measurements were repeated with no external load, 90 N anterior draw force, and 5 Nm internal and 5 Nm external rotation torque applied. Results The anterior sMCL lengthened with flexion (p < 0.01) and further lengthened by external rotation (p < 0.001). The posterior sMCL slackened with flexion (p < 0.001), but was lengthened by internal rotation (p < 0.05). External rotation lengthened the anterior dMCL fibres by 10% throughout flexion (p < 0.001). sMCL release allowed the dMCL to become taut with valgus rotation (p < 0.001). The anterior and posterior POL fibres slackened with flexion (p < 0.001), but were elongated by internal rotation (p < 0.001). Conclusion The structures of the medial ligament complex react differently to knee flexion and applied loads. Structures attaching posterior to the medial epicondyle are taut in extension, whereas the anterior sMCL, attaching anterior to the epicondyle, is tensioned during flexion. The anterior dMCL is elongated by external rotation. These data offer the basis for MCL repair and reconstruction techniques regarding graft positioning and tensioning.

The Function of the Short Medial Collateral Ligaments of the Canine Tarsus: A Cadaveric Study

2019 ◽  
Vol 55 (5) ◽  
pp. 215-219
Author(s):  
Sandra Bogisch ◽  
Riccarda Schuenemann
Keyword(s):  
Internal Rotation ◽  
Medial Collateral Ligament ◽  
External Rotation ◽  
Collateral Ligaments ◽  
Ligament Injuries ◽  
Collateral Ligament ◽  
Clinical Behavior ◽  
Varus Angulation ◽  
Before And After ◽  
K Wires

ABSTRACT Information on the clinical behavior of cases with an isolated rupture of the short collateral ligaments of the canine tarsus is sparse. Our objective was to evaluate the function of the short medial collateral ligaments (SMCLs) in 90° flexion. Eight cadaveric limbs were tested for internal/external rotation and valgus/varus before and after transection of one or both SMCLs. In one group, the tibiocentral ligament was transected first, followed by the tibiotalar. In the second group, the order of transection was reversed. Angular changes between two k-wires were measured and compared. Internal rotation increased significantly after transection of one or both SMCLs (P = .015 and P = .004), with higher angular changes in the group in which the tibiotalar ligament was transected first (P = .003). Transection of this ligament alone was sufficient to cause caudomedial subluxation upon internal rotation. Valgus angulation increased after transection of one ligament (P = .022), but there was also an increase in varus angulation after transection of both ligaments (P = .027). Unlike the long medial collateral ligament, which stabilizes against deviation toward lateral, the SMCL stabilizes against subluxation toward medial, with the tibiotalar ligament being the major stabilizer in flexion. Findings can be used as diagnostic guidance for isolated tarsal short collateral ligament injuries.

scholarly journals Posteromedial Ligament Repair of the Knee with Suture Tape Augmentation: A Biomechanical Comparison with Posteromedial Ligament Reconstruction

2020 ◽  
Vol 8 (5_suppl4) ◽  
pp. 2325967120S0029
Author(s):  
Julian Mehl ◽  
Cameron Kia ◽  
Elifho Obopilwe ◽  
Mark Cote ◽  
Florian Imhoff ◽  
...  
Keyword(s):  
Internal Rotation ◽  
Knee Flexion ◽  
Ligament Reconstruction ◽  
External Rotation ◽  
Ligament Repair ◽  
Rotatory Instability ◽  
Valgus Instability ◽  
Tendon Grafts ◽  
Femoral Avulsion ◽  
Suture Tape

Aims and Objectives: ACL ruptures combined with injuries of the superficial medial collateral ligament and posterior oblique ligament (= posteromedial ligament complex; PMC) are common. In acute cases with high-grade valgus and rotatory instability, primary repair of the PMC with suture tape augmentation may be a reasonable alternative to standard reconstruction techniques, in order to stabilize the knee and to protect the reconstructed ACL. The aim of the present study was to biomechanically examine the rotational and valgus stability, as well as the influence on ACL strain, following PMC repair with suture tape augmentation in comparison with posteromedial ligament reconstruction using tendon grafts. Materials and Methods: Ten cadaveric knee specimens were tested with the tibia fixed and the femur mobile on an X-Y-table. Each specimen was tested in four different conditions according to the state of the PMC: 1) native, 2) femoral avulsion, 3) repaired with suture tape augmentation, 4) reconstructed with tendon allografts. Valgus instability was tested with 40 N force applied in the lateral direction of the femur and rotational motion was tested with 5 N torque applied to the tibia. An optical 3D motion tracking system captured the valgus angle and the internal and external rotation. Additionally, the strain on the ACL during valgus stress was measured with a DVRT. Each condition was tested in 0°, 15°, 30°, 45° and 60° of knee flexion. Results: Femoral avulsion of the PMC led to a significant increase in valgus instability in all flexion angles and to a significant increase on ACL strain at 30° (Native 1.37 ± 2.33 vs. deficient 7.49 ± 7.00; p<0.001) and 45° (0.88 ± 1.66 vs. 2.82 ± 2.59; p<0.001) knee flexion. Additionally, a significant increase of internal rotation in 0° (p=0.018) and 30° (p=0.005) knee flexion and a significant increase of external rotation in 15° (p<0.001), 30° (p=0.016), 45° (p=0.006) and 60° (p=0.012) knee flexion was seen after dissection of the PMC. PMC repair with suture tape augmentation demonstrated similar valgus and rotational stability compared to intact specimens, with the exception of increased internal rotation at 30° (16.2 ± 6.3° vs. 19.3 ± 6.9°; p=0.005). PMC reconstruction with tendon grafts led to a significantly increased valgus opening at a 45° degree of knee flexion (7.5 ± 2.9° vs. 8.9 ± 2.1°; p=0.048) and significantly increased internal rotation at 30° (16.2 ± 6.3° vs. 20.1 ± 7.3°; p<0.001) compared to the native state. Direct comparison between both surgical techniques showed no significant differences. Conclusion: At time zero, ligament repair of the posteromedial knee with suture tape augmentation restored close to native valgus and rotatory stability, as well as native ACL strain for cases of complete PMC avulsion. Posteromedial ligament repair with suture tape augmentation may be a reasonable alternative to tendon reconstruction techniques in acute cases of combined posteromedial and ACL injuries with high-grade valgus and rotatory instability.

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