Abstract
BackgroundThe purpose of this study was to evaluate and compare knee kinematics and stability following either triangular or anatomical reconstruction of the superficial medial collateral ligament (sMCL) and posterior oblique ligament (POL).MethodsIn a cadaveric model (12 knees), the stability and kinematics following two experimental sMCL and POL reconstructions were compared in sMCL- and POL-deficient knees versus normal knees. The first reconstruction was a triangular reconstruction of the sMCL and POL, while the second involved an anatomical reconstruction of the sMCL and POL. All knees were tested through four different states. The changes in valgus angles, external rotation, and internal rotation were measured in the normal and sMCL- and POL-deficient knees, as well as in the knees that had undergone the two different forms (triangular and anatomical) of reconstruction.ResultsAfter initial sectioning of the sMCL and POL, we observed significantly increased valgus rotation, external rotation, and internal rotation at all knee flexion angles (0°, 20°, 30°, 60°, 90°). Additionally, passive stability testing demonstrated a significant increase in tibial internal rotation following triangular reconstruction compared with anatomical reconstruction at knee flexion angles of 20° and 30°. A significant increase in internal rotation was present following triangular reconstruction compared with anatomical reconstruction at 20° (mean difference = 2.77) (P = 0.008) and 30° (mean difference = 0.99) (P < 0.001) of knee flexion.ConclusionThis study suggests that anatomical sMCL and POL reconstruction produces slightly better biomechanical stability than triangular reconstruction. However, triangular reconstruction may restore a near-normal knee joint is both less invasive and more practical.
Highlights
The purpose of this study was to evaluate and compare knee kinematics and stability following either triangular or anatomical reconstruction of the superficial medial collateral ligament and posterior oblique ligament (POL)
From a biomechanical point of view, the superficial medial collateral ligament (sMCL) contributes 78% of the stability in valgus and external rotation at 25° of knee flexion, and the POL plays a primary role in internal rotation and preventing valgus when knee flexion is between 0°~ 30° [8, 13]
After initial sectioning of the sMCL and POL, we observed significantly increased valgus rotation at all knee flexion angles (0°, 20°, 30°, 60°, 90°)
Summary
The purpose of this study was to evaluate and compare knee kinematics and stability following either triangular or anatomical reconstruction of the superficial medial collateral ligament (sMCL) and posterior oblique ligament (POL). Isolated medial collateral ligament (MCL) injury often does not require surgical treatment [1,2,3]. The superficial MCL (sMCL) plays a major role in valgus stability of the knee joint, and a secondary role in internal and external rotation stability [8, 9]. The posterior oblique ligament (POL) has an important function in rotational stability, and a secondary function in valgus and external rotation stability [10,11,12]. From a biomechanical point of view, the sMCL contributes 78% of the stability in valgus and external rotation at 25° of knee flexion, and the POL plays a primary role in internal rotation and preventing valgus when knee flexion is between 0°~ 30° [8, 13]. It is clear that repairing the sMCL and POL efficiently simultaneously plays a dominant role in the stability and biomechanics of the knee joint [6]
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