J Knee Surg 2013; 26(03): 179-184
DOI: 10.1055/s-0032-1327451
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Medial Collateral Ligament Recession for Chronic Medial Knee Laxity

Jeffrey R. Backes
1   Department of Orthopedic Surgery, Mount Carmel Medical Center, Columbus, Ohio
,
Roger E. Wiltfong
1   Department of Orthopedic Surgery, Mount Carmel Medical Center, Columbus, Ohio
,
Robert N. Steensen
1   Department of Orthopedic Surgery, Mount Carmel Medical Center, Columbus, Ohio
› Institutsangaben
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Publikationsverlauf

24. März 2012

22. Juli 2012

Publikationsdatum:
11. Oktober 2012 (online)

Abstract

The medial collateral ligament (MCL) is the primary restraint to valgus stress of the knee. Although the MCL has demonstrated an ability to reliably heal with conservative management, chronic medial instability has been well described following an isolated MCL injury or in combination with an anterior cruciate ligament (ACL) tear. When the MCL heals with persistent medial laxity surgical treatment may be necessary to prevent chronic medial instability and valgus overload of a reconstructed cruciate ligament. We present a simple technique for MCL recession that can be used for isolated MCL laxity as well as in chronic ACL/MCL knee injuries. This technique allows for secure fixation with bone-to-bone healing, avoids donor-site morbidity, maintains relative MCL isometry, and can be performed through a modest incision.

 
  • References

  • 1 Grood ES, Noyes FR, Butler DL, Suntay WJ. Ligamentous and capsular restraints preventing straight medial and lateral laxity in intact human cadaver knees. J Bone Joint Surg Am 1981; 63 (8) 1257-1269
  • 2 Azar FM. Evaluation and treatment of chronic medial collateral ligament injuries of the knee. Sports Med Arthrosc 2006; 14 (2) 84-90
  • 3 Papalia R, Osti L, Del Buono A, Denaro V, Maffulli N. Management of combined ACL-MCL tears: a systematic review. Br Med Bull 2010; 93: 201-215
  • 4 Stannard JP. Medial and posteromedial instability of the knee: evaluation, treatment, and results. Sports Med Arthrosc 2010; 18 (4) 263-268
  • 5 Canata GL, Chiey A, Leoni T. Surgical technique: does mini-invasive medial collateral ligament and posterior oblique ligament repair restore knee stability in combined chronic medial and ACL injuries?. Clin Orthop Relat Res 2012; 470 (3) 791-797
  • 6 Yoshiya S, Kuroda R, Mizuno K, Yamamoto T, Kurosaka M. Medial collateral ligament reconstruction using autogenous hamstring tendons: technique and results in initial cases. Am J Sports Med 2005; 33 (9) 1380-1385
  • 7 Shelbourne KD, Porter DA. Anterior cruciate ligament-medial collateral ligament injury: Nonoperative management of medial collateral ligament tears with anterior cruciate ligament reconstruction: A preliminary report. Am J Sports Med 1992; 23: 380-389
  • 8 Halinen J, Lindahl J, Hirvensalo E, Santavirta S. Operative and nonoperative treatments of medial collateral ligament rupture with early anterior cruciate ligament reconstruction: a prospective randomized study. Am J Sports Med 2006; 34 (7) 1134-1140
  • 9 Miyamoto RG, Bosco JA, Sherman OH. Treatment of medial collateral ligament injuries. J Am Acad Orthop Surg 2009; 17 (3) 152-161
  • 10 Zaffagnini S, Bonanzinga T, Marcheggiani Muccioli GM , et al. Does chronic medial collateral ligament laxity influence the outcome of anterior cruciate ligament reconstruction?: a prospective evaluation with a minimum three-year follow-up. J Bone Joint Surg Br 2011; 93 (8) 1060-1064
  • 11 Feeley BT, Muller MS, Allen AA, Gracchi CC, Pearle AD. Biomechanical comparison of medial collateral ligament reconstructions using computer-assisted navigation. Am J Sports Med 2009; 37 (6) 1123-1130
  • 12 Marx RG, Hetsroni I. Surgical technique: medial collateral ligament reconstruction using Achilles allograft for combined knee ligament injury. Clin Orthop Relat Res 2012; 470 (3) 798-805
  • 13 Kovachevich R, Shah JP, Arens AM, Stuart MJ, Dahm DL, Levy BA. Operative management of the medial collateral ligament in the multi-ligament injured knee: an evidence-based systematic review. Knee Surg Sports Traumatol Arthrosc 2009; 17 (7) 823-829
  • 14 Kim SJ, Lee DH, Kim TE, Choi NH. Concomitant reconstruction of the medial collateral and posterior oblique ligaments for medial instability of the knee. J Bone Joint Surg Br 2008; 90 (10) 1323-1327
  • 15 Osti L, Papalia R, Del Buono A, Merlo F, Denaro V, Maffulli N. Simultaneous surgical management of chronic grade-2 valgus instability of the knee and anterior cruciate ligament deficiency in athletes. Knee Surg Sports Traumatol Arthrosc 2010; 18 (3) 312-316
  • 16 Duffy PS, Miyamoto RG. Management of medial collateral ligament injuries in the knee: an update and review. Phys Sportsmed 2010; 38 (2) 48-54
  • 17 Lind M, Jakobsen BW, Lund B, Hansen MS, Abdallah O, Christiansen SE. Anatomical reconstruction of the medial collateral ligament and posteromedial corner of the knee in patients with chronic medial collateral ligament instability. Am J Sports Med 2009; 37 (6) 1116-1122
  • 18 Van den Bogaerde JM, Shin E, Neu CP, Marder RA. The superficial medial collateral ligament reconstruction of the knee: effect of altering graft length on knee kinematics and stability. Knee Surg Sports Traumatol Arthrosc 2011; 19 (Suppl. 01) S60-S68
  • 19 Feeley BT, Muller MS, Allen AA, Granchi CC, Pearle AD. Isometry of medial collateral ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2009; 17 (9) 1078-1082
  • 20 LaPrade RF, Engebretsen AH, Ly TV, Johansen S, Wentorf FA, Engebretsen L. The anatomy of the medial part of the knee. J Bone Joint Surg Am 2007; 89 (9) 2000-2010
  • 21 Victor J, Wong P, Witvrouw E, Sloten JV, Bellemans J. How isometric are the medial patellofemoral, superficial medial collateral, and lateral collateral ligaments of the knee?. Am J Sports Med 2009; 37 (10) 2028-2036
  • 22 Healy WL, Iorio R, Lemos DW. Medial reconstruction during total knee arthroplasty for severe valgus deformity. Clin Orthop Relat Res 1998; (356) 161-169