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.

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.

Posteromedial Ligament Repair of the Knee With Suture Tape Augmentation: A Biomechanical Study

2019 ◽  
Vol 47 (12) ◽  
pp. 2952-2959 ◽  
Author(s):  
Julian T. Mehl ◽  
Cameron Kia ◽  
Matthew Murphy ◽  
Elifho Obopilwe ◽  
Mark Cote ◽  
...  
Keyword(s):  
Internal Rotation ◽  
Knee Flexion ◽  
Primary Repair ◽  
Cruciate Ligament ◽  
Surgical Techniques ◽  
Ligament Repair ◽  
Acl Injuries ◽  
Tendon Reconstruction ◽  
Reasonable Alternative ◽  
Suture Tape

Background: In cases of acute combined posteromedial and anterior cruciate ligament (ACL) injuries, primary repair of the superficial medial collateral ligament (sMCL) and posterior oblique ligament (POL) with suture tape augmentation may be a reasonable alternative to standard tendon reconstruction techniques. Purpose/Hypothesis: The purpose was to examine the rotational and valgus laxity with ACL strain following sMCL and POL repair with suture tape augmentation at various degrees of knee flexion. It was hypothesized that this technique would restore knee laxity and kinematics comparable with those of the intact state. Study Design: Controlled laboratory study. Methods: Ten cadaveric knee specimens (mean ± SD, 57.9 ± 5.9 years) were obtained. Specimens were tested with the tibia fixed and the femur mobile on an X-Y table. Each specimen was tested in 4 conditions according to the state of the sMCL and POL: native, deficient, repaired with suture tape augmentation, and reconstructed with tendon allografts. Valgus laxity 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. ACL strain during valgus stress was also measured. Each condition was tested in 0°, 15°, 30°, 45°, and 60° of knee flexion. Results: Dissection of the sMCL and POL led to significantly increased valgus laxity in all flexion angles, with a significant increase in ACL strain at 30° ( P < .001) and 45° ( P < .001). Ligament repair with suture tape augmentation demonstrated similar valgus and rotational laxity as compared with intact specimens, with the exception of increased internal rotation at 30° ( P = .005). Ligament reconstruction resulted in significantly increased valgus opening at 45° ( P = .048) and significantly increased internal rotation at 30° ( P < .001) as compared with the native state. Direct comparison between 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 laxity, as well as native ACL strain for cases of complete sMCL and POL avulsion. Clinical Relevance: Ligament repair of the sMCL and POL with suture tape augmentation may be a reasonable alternative to tendon reconstruction techniques in cases of acute combined posteromedial and ACL injuries with valgus and rotatory instability.

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.

Novel Suture Anchor Technique with Continuous Locking Stitch for Collateral Ligament Repair

2016 ◽  
Vol 21 (02) ◽  
pp. 276-279
Author(s):  
Susumu Tokunaga ◽  
Yoshihiro Abe
Keyword(s):  
Suture Anchor ◽  
Finger Joint ◽  
Suture Techniques ◽  
Collateral Ligaments ◽  
Ligament Repair ◽  
Collateral Ligament ◽  
Rotatory Instability ◽  
Pull Out ◽  
Valgus Instability

Collateral ligaments are difficult to repair due to large amount of fraying in detached ligaments and attenuated stumps that may not provide enough strength after the repair. Although strong locking sutures are used to repair the ligament with proper tension, these damages can cause pull-out failure or relaxation of the repaired ligaments even from undersized load that may extend postoperative splinting or casting time. Furthermore, current suture techniques can repair varus or valgus instability of the elbow and radial or ulnar instability of the fingers, but these techniques do not offer rotatory stability of these areas. We have developed a novel suture anchor technique that has overcome this problem of current suture techniques, and this can be used to correct rotatory instability in the elbow and fingers. We used this procedure in seven cases with injury of collateral ligament in the elbow and eight cases with detached collateral ligaments of finger joint. No patient experienced rerupture or any kind of residual instability. We believe that the proposed method can produce much stronger repair and may shorten the postoperative immobilization period.

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.

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