scholarly journals Bone Staples Provide Favorable Primary Stability in Cortical Fixation of Tendon Grafts for Medial Collateral Ligament Reconstruction: A Biomechanical Study

2021 ◽  
Vol 9 (7) ◽  
pp. 232596712110178
Author(s):  
Johannes Glasbrenner ◽  
Adrian Deichsel ◽  
Michael J. Raschke ◽  
Thorben Briese ◽  
Andre Frank ◽  
...  
Keyword(s):  
Cyclic Loading ◽  
Medial Collateral Ligament ◽  
Ligament Reconstruction ◽  
Failure Load ◽  
Primary Stability ◽  
Tendon Graft ◽  
Materials Testing ◽  
Collateral Ligament ◽  
Load To Failure ◽  
Tendon Grafts

Background: The use of the interference screw (IFS) for the cortical fixation of tendon grafts in knee ligament reconstruction may lead to converging tunnels in the multiligament reconstruction setting. It is unknown whether alternative techniques using modern suture anchor (SA) or bone staple (BS) fixation provide sufficient primary stability. Purpose: To assess the primary stability of cortical fixation of tendon grafts for medial collateral ligament (MCL) reconstruction using modern SA and BS methods in comparison with IFS fixation. Study Design: Controlled laboratory study. Methods: Cortical tendon graft fixation was performed in a porcine knee model at the tibial insertion area of the MCL using 3 different techniques: IFS (n = 10), SA (n = 10), and BS (n = 10). Specimens were mounted in a materials testing machine, and cyclic loading for 1000 cycles at up to 100 N was applied to the tendon graft, followed by load-to-failure testing. Statistical analysis was performed using 1-way analysis of variance. Results: There were no statistical differences in elongation during cyclic loading or peak failure load during load-to-failure testing between BS (mean ± standard deviation: 3.4 ± 1.0 mm and 376 ± 120 N, respectively) and IFS fixation (3.9 ± 1.2 mm and 313 ± 99.5 N, respectively). SA fixation was found to have significantly more elongation during cyclic loading (6.4 ± 0.9 mm; P < .0001) compared with BS and IFS fixation and lower peak failure load during ultimate failure testing (228 ± 49.0 N; P < .01) compared with BS fixation. Conclusion: BS and IFS fixation provided comparable primary stability in the cortical fixation of tendon grafts in MCL reconstruction, whereas a single SA fixation led to increased elongation with physiologic loads. However, load to failure of all 3 fixation techniques exceeded the loads expected to occur in the native MCL. Clinical Relevance: The use of BS as a reliable alternative to IFS fixation for peripheral ligament reconstruction in knee surgery can help to avoid the conflict of converging tunnels.

scholarly journals Medial Collateral Ligament Reconstruction in Patients With Medial Knee Instability: A Systematic Review

2017 ◽  
Vol 5 (5) ◽  
pp. 232596711770392 ◽  
Author(s):  
Antonios N. Varelas ◽  
Brandon J. Erickson ◽  
Gregory L. Cvetanovich ◽  
Bernard R. Bach
Keyword(s):  
Systematic Review ◽  
Range Of Motion ◽  
Medial Collateral Ligament ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Collateral Ligament ◽  
Level Of Evidence ◽  
Cruciate Ligament Reconstruction ◽  
Significant Difference ◽  
Ikdc Score

Background: The medial collateral ligament (MCL) is the most frequently injured ligament of the knee, but it infrequently requires surgical treatment. Current literature on MCL reconstructions is sparse and offers mixed outcome measures. Purpose/Hypothesis: The purpose of this study was to compare the outcomes of isolated MCL reconstruction and multiligamentous MCL reconstruction. Our hypothesis was that in selective patients, MCL reconstruction would significantly improve objective and subjective patient knee performance measures, those being baseline valgus laxity, range of motion, objective and subjective International Knee Documentation Committee (IKDC) scores, Tegner score, and Lysholm knee activity scores. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines and utilizing 3 computer-based databases. Studies reporting clinical outcomes of patients undergoing MCL reconstruction due to chronic instability or injury with mean follow-up of at least 2 years and levels of evidence 1 to 4 were eligible for inclusion. All relevant subject demographics and study data were statistically analyzed using 2-sample and 2-proportion z tests. Results: Ten studies involving 275 patients met our inclusion criteria. Of these patients, 46 underwent isolated MCL reconstruction while another 229 underwent reconstruction of the MCL in addition to a variety of concomitant reconstructions. Overall outcomes for all patients were significant for (1) reducing the medial opening of the knee (8.1 ± 1.3 vs 1.4 ± 1.0 mm; P < .001), (2) improving the patient’s objective IKDC score (1.2% vs 88.4%; P < .001), (3) improving the patient’s subjective IKDC score (49.8 ± 6.9 vs 82.4 ± 9.6; P < .001), and (4) improving the Lysholm knee activity score (69.3 ± 5.9 vs 90.5 ± 6.6; P < .001). No differences existed between concomitant reconstruction groupings except that postoperative Lysholm scores were better for MCL/anterior cruciate ligament reconstruction than MCL/posterior cruciate ligament reconstruction (94.3 ± 4.5 vs 84.0 ± 11.7; P < .001). Normal or nearly normal range of motion was obtained by 88% of all patients. Conclusion: The systematic review of 10 studies and 275 knees found that the reported patient outcomes after MCL reconstruction were significantly improved across all measures studied, with no significant difference in outcomes between concomitant reconstructions.

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.

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