scholarly journals Medial collateral ligament release during knee arthroscopy: key concepts

2021 ◽  
Vol 6 (8) ◽  
pp. 669-675
Author(s):  
Vicente Carlos da Silva Campos ◽  
Francisco Guerra Pinto ◽  
Diogo Constantino ◽  
Renato Andrade ◽  
João Espregueira-Mendes
Keyword(s):  
Medial Meniscus ◽  
Knee Arthroscopy ◽  
Cartilage Damage ◽  
Joint Space ◽  
Medial Compartment ◽  
Collateral Ligament ◽  
Tibiofemoral Joint ◽  
Key Concepts ◽  
Complete Access ◽  
Inside Out

Complete access to the posterior medial compartment of the knee may represent a technical challenge during arthroscopy in patients with a tight tibiofemoral joint space. Medial collateral release reduces direct iatrogenic cartilage damage in the medial compartment of the knee through manipulation with instruments. We recommend performing medial collateral release in surgeries that access the posteromedial compartment (e.g. partial meniscectomy for ruptures of the posterior horn of medial meniscus or posterior root repairs) when the patient has a tight tibiofemoral joint space. There are two main techniques to perform medial collateral release: inside-out and outside-in. Regardless of the technique used, releasing medial ligament structures is a safe and effective method to be used in the diagnosis and treatment of injuries to the medial compartment. Cite this article: EFORT Open Rev 2021;6:669-675. DOI: 10.1302/2058-5241.6.200128

scholarly journals Needle assisted arthroscopic clysis of the medial collateral ligament of the knee: a simple technique to improve exposure in arthroscopic knee surgery

2013 ◽  
Vol 5 (4) ◽  
pp. 38 ◽  
Author(s):  
Xinning Li ◽  
Ronald M. Selby ◽  
Ashley Newman ◽  
Stephen J. O'Brien
Keyword(s):  
Medial Collateral Ligament ◽  
Tibial Plateau ◽  
Medial Meniscus ◽  
Knee Arthroscopy ◽  
Medial Compartment ◽  
Spinal Needle ◽  
Collateral Ligament ◽  
Valgus Stress ◽  
Posteromedial Corner ◽  
Arthroscopic Knee

During knee arthroscopy, narrowness and tightness maybe encountered in the medial compartment that does not allow sufficient visualization or instrumentation. When this occurs, our team has found it helpful to perform a percutaneous clysis of the deep portion of the medial collateral ligament with a spinal needle. With the knee positioned in 10° to 20° of flexion and a valgus stress is applied. A spinal needle (18 Gauge) is passed percutaneously through the medial collateral ligament between the tibial plateau and undersurface of the medial meniscus. Several passes are made with the spinal needle with the bevel of the needle angled to selectively divide the fibers while keeping the medial collateral ligament under tension. Then with controlled valgus force, the medial compartment will progressively open allowing improved visualization to the posteromedial corner of the knee. This increase in space gives an enhanced visual field and further allows more room for arthroscopic instrumentation.

Objective Measurement of Medial Joint Space Widening with Percutaneous “Pie Crust” Release of Medial Collateral Ligament during Knee Arthroscopy

2019 ◽  
Vol 33 (01) ◽  
pp. 094-098 ◽  
Author(s):  
Barış Polat ◽  
Deniz Aydın ◽  
Ayşe Esin Polat ◽  
Tahsin Gürpınar ◽  
Enes Sarı ◽  
...  
Keyword(s):  
Medial Collateral Ligament ◽  
Knee Arthroscopy ◽  
Office Visit ◽  
Joint Space ◽  
Objective Measurement ◽  
Neutral Position ◽  
Collateral Ligament ◽  
Medial Side ◽  
Joint Space Widening

AbstractKnee arthroscopy may be called the most commonly and increasingly performed orthopaedic procedure. Posterior medial compartment visualization may be quite challenging. The aim of the present study is to detect objective measurement of medial joint space widening with percutaneous “pie crust” release of medial collateral ligament (MCL) during knee arthroscopy. We used this technique for all knees that require any intervention in the posteromedial compartment and for tight knees in which adequate visualization of the posteromedial compartment cannot be obtained. Eighteen patients (18 knees) were included in this study. Patients were evaluated clinically with the Lysholm and Tegner scores at the final office visit. Joint balance, valgus instability, pain or tenderness on MCL region, and numbness over the medial side of the joint were also noted. Measurements of medial joint space (mm) were obtained at three different times with perioperative C-arm images: normal, controlled valgus force, and after pie crusting. The median follow-up time was 9 (6–12) months. Final follow-up Lysholm (p < 0.05) and Tegner scores (p < 0.05) increased significantly compared with preoperative scores. At the final follow-up, there was no pain or tenderness over MCL and there were no signs of saphenous nerve or vein injury. Medial joint space values in after pie crusting increased significantly (p < 0.05) compared with neutral position measurements and controlled valgus force application (p < 0.05). Controlled release of the MCL in knees provided ∼2.45 times wider visualization place. Furthermore, pie crusting of MCL is a safe and effective technique that provides enough space for visualization and instrumentation in knees. This is a Level IV study.

scholarly journals Difference in the joint space of the medial knee compartment between full extension and Rosenberg weight-bearing radiographs

2021 ◽  
Author(s):  
Yugo Miura ◽  
Nobutake Ozeki ◽  
Hisako Katano ◽  
Hayato Aoki ◽  
Noriya Okanouchi ◽  
...  
Keyword(s):  
Correlation Coefficient ◽  
Medial Meniscus ◽  
Joint Space Width ◽  
Joint Space ◽  
Cartilage Thickness ◽  
Medial Compartment ◽  
The Difference ◽  
Medial Meniscus Extrusion ◽  
Meniscus Extrusion ◽  
And Cartilage

Abstract Objectives Radiographs are the most widespread imaging tool for diagnosing osteoarthritis (OA) of the knee. Our purpose was to determine which of the two factors, medial meniscus extrusion (MME) or cartilage thickness, had a greater effect on the difference in the minimum joint space width (mJSW) at the medial compartment between the extension anteroposterior view (extension view) and the 45° flexion posteroanterior view (Rosenberg view). Methods The subjects were 546 participants (more than 50 females and 50 males in their 30 s, 40 s, 50 s, 60 s, and 70 s) in the Kanagawa Knee Study. The mJSW at the medial compartment was measured from both the extension and the Rosenberg views, and the “mJSW difference” was defined as the mJSW in the Rosenberg view subtracted from the mJSW in the extension view. The cartilage region was automatically extracted from MRI data and constructed in three dimensions. The medial region of the femorotibial joint cartilage was divided into 18 subregions, and the cartilage thickness in each subregion was determined. The MME was also measured from MRI data. Results The mJSW difference and cartilage thickness were significantly correlated at 4 subregions, with 0.248 as the highest absolute value of the correlation coefficient. The mJSW difference and MME were also significantly correlated, with a significantly higher correlation coefficient (0.547) than for the mJSW difference and cartilage thickness. Conclusions The MME had a greater effect than cartilage thickness on the difference between the mJSW at the medial compartment in the extension view and in the Rosenberg view. Key Points • The difference in the width at the medial compartment of the knee between the extension and the flexion radiographic views was more affected by medial meniscus extrusion than by cartilage thickness.

scholarly journals The relationship between chondromalacia patella, medial meniscal tear and medial periarticular bursitis in patients with osteoarthritis

2017 ◽  
Vol 51 (4) ◽  
pp. 401-406 ◽  
Author(s):  
Mustafa Resorlu ◽  
Davut Doner ◽  
Ozan Karatag ◽  
Canan Akgun Toprak
Keyword(s):  
Medial Meniscus ◽  
Meniscal Tear ◽  
Lateral Collateral Ligament ◽  
Lateral Compartment ◽  
Medial Compartment ◽  
Meniscus Tear ◽  
Collateral Ligament ◽  
Medial Meniscal Tear ◽  
Chondromalacia Patella ◽  
Grade Iii

Abstract Background This study investigated the presence of bursitis in the medial compartment of the knee (pes anserine, semimembranosus-tibial collateral ligament, and medial collateral ligament bursa) in osteoarthritis, chondromalacia patella and medial meniscal tears. Patients and methods Radiological findings of 100 patients undergoing magnetic resonance imaging with a preliminary diagnosis of knee pain were retrospectively evaluated by two radiologists. The first radiologist assessed all patients in terms of osteoarthritis, chondromalacia patella and medial meniscal tear. The second radiologist was blinded to these results and assessed the presence of bursitis in all patients. Results Mild osteoarthritis (grade I and II) was determined in 55 patients and severe osteoarthritis (grade III and IV) in 45 cases. At retropatellar cartilage evaluation, 25 patients were assessed as normal, while 29 patients were diagnosed with mild chondromalacia patella (grade I and II) and 46 with severe chondromalacia patella (grade III and IV). Medial meniscus tear was determined in 51 patients. Severe osteoarthritis and chondromalacia patella were positively correlated with meniscal tear (p < 0.001 and p = 0.018, respectively). Significant correlation was observed between medial meniscal tear and bursitis in the medial compartment (p = 0.038). Presence of medial periarticular bursitis was positively correlated with severity of osteoarthritis but exhibited no correlation with chondromalacia patella (p = 0.023 and p = 0.479, respectively). Evaluation of lateral compartment bursae revealed lateral collateral ligament bursitis in 2 patients and iliotibial bursitis in 5 patients. Conclusions We observed a greater prevalence of bursitis in the medial compartment of the knee in patients with severe osteoarthritis and medial meniscus tear.

scholarly journals Biomechanical characteristics of tibio-femoral joint after partial medial meniscectomy in different flexion angles: a finite element analysis

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Xiaohui Zhang ◽  
Shuo Yuan ◽  
Jun Wang ◽  
Bagen Liao ◽  
De Liang
Keyword(s):  
Finite Element ◽  
Articular Cartilage ◽  
Finite Element Model ◽  
Medial Meniscus ◽  
Lateral Meniscus ◽  
Element Model ◽  
Magnetic Resonance Images ◽  
Biomechanical Analysis ◽  
Joint Stress ◽  
Tibiofemoral Joint

Abstract Background Recent studies have pointed out that arthroscopy, the commonly-used surgical procedure for meniscal tears, may lead to an elevated risk of knee osteoarthritis (KOA). The biomechanical factors of KOA can be clarified by the biomechanical analysis after arthroscopic partial meniscectomy (APM). This study aimed to elucidate the cartilage stress and meniscus displacement of the tibiofemoral joint under flexion and rotation loads after APM. Methods A detailed finite element model of the knee bone, cartilage, meniscus, and major ligaments was established by combining computed tomography and magnetic resonance images. Vertical load and front load were applied to simulate different knee buckling angles. At the same time, by simulating flexion of different degrees and internal and external rotations, the stresses on tibiofemoral articular cartilage and meniscus displacement were evaluated. Results Generally, the contact stress on both the femoral tibial articular cartilage and the meniscus increased with the increased flexion degree. Moreover, the maximum stress on the tibial plateau gradually moved backward. The maximum position shift value of the lateral meniscus was larger than that of the medial meniscus. Conclusion Our finite element model provides a realistic three-dimensional model to evaluate the influence of different joint range of motion and rotating tibiofemoral joint stress distribution. The decreased displacement of the medial meniscus may explain the higher pressure on the knee components. These characteristics of the medial tibiofemoral joint indicate the potential biomechanical risk of knee degeneration.

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