Chronic Medial Collateral Ligament Research Articles

Clinical Results of Isolated MCL Grade III Injury in Acute and Chronic Setting: Systematic Review and Meta-analysis.

The medial collateral ligament (MCL) is frequently involved in injuries around the knee but is uncommonly treated surgically. There are various techniques to reconstruct the medial side of the knee, which have varying outcomes. The purpose of the present systematic review and meta-analysis is to describe the clinical results of surgical management of acute and chronic isolated grade III MCL injury using various functional scores, such as IKDC, Lysholm, and VAS, and to ascertain complication rates associated with these interventions. A systematic review was performed according to the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines, and two independent authors (L.F and A.M) conducted a comprehensive search across multiple databases (PubMed, Web of Science, and Scopus). They reviewed each article's title and abstract for studies available until April 2024. The search terms used were "((MCL) OR (Medial collateral ligament)) AND (injuries) AND (treatment)". The full texts of the studies were evaluated when eligibility could not be assessed from the title and abstract. The pooled proportion (percentage) of complications from the three studies reporting data on surgery for the MCL acute stage was 15.3% with 95% CI [6.1% to 24.6%]. No complications were reported in studies reporting surgery in the chronic stage. Marked resolution of pain was observed with the mean VAS Score for pain at the final follow-up after surgery for MCL injury in the acute stage was 0.4 with 95% CI [-0.04 to 0.84]. The mean IKDC score at the final follow-up in the three studies reporting data on surgery for the MCL in the acute stage was 79.39 with 95% CI [67.96 to 90.82], and in the chronic stage, was 85 with 95% CI [83.02 to 86.98]. The mean Lysholm Score at the final follow-up after surgery for MCL injury in the chronic stage was 83.04 with 95% CI [75.24 to 94.84], and in the acute stage was 95 with 95% CI [91.76 to 98.24]. This systematic review found that functional outcomes regarding IKDC and LYSHOLM scores were comparable for surgeries performed in acute and chronic MCL tears. There was a marginally increased risk of complication in surgeries performed for acute MCL tears. Compared to the acute phase, a marked resolution of pain was observed at the final follow-up after surgery for MCL injury. Systematic review; level of evidence, 4..

Anterior Cruciate Ligament Over-The-Top Plus Lateral Plasty and Minimally Invasive Double-Bundle Posteromedial Corner Reconstruction

The medial collateral ligament (MCL) and the posteromedial corner (PMC) of the knee are essential structures for maintaining medial knee stability. Chronic MCL instability is infrequent but can necessitate surgical intervention. Various surgical techniques have been described, but they often involve the use of tibial tunnels, which may complicate concurrent ligament reconstructions. This study aims to present a minimally invasive double-bundle PMC reconstruction technique that avoids the use of tibial tunnels. Knee evaluation was performed using standard clinical tests and 1.5-Tesla magnetic resonance imaging. Patients with grade III Hughston MCL injuries were considered for surgery. The technique employs either an autologous semitendinosus graft or a fresh-frozen allograft, usually tibialis anterior, to reconstruct both the superficial MCL and the posterior oblique ligament. The technique described avoids the use of tibial tunnels, preserving tibial bone stock for any future procedures. The graft is secured at the femoral and tibial insertions using bioabsorbable interference screws and titanium staples, respectively. Our minimally invasive double-bundle PMC reconstruction technique offers a feasible and effective solution for patients with chronic medial knee instability. It is particularly beneficial for patients requiring multiple ligament reconstructions, as it avoids tunnel collision and preserves tibial bone stock.

Opening-Wedge Distal Femoral Osteotomy With Concomitant Medial Meniscal Root Repair

Background: Valgus malalignment leads to excessive loading of the lateral compartment and has been associated with lateral compartment meniscal injuries and early-onset knee osteoarthritis. Distal femoral osteotomy (DFO) is a treatment option that allows correction of the mechanical access to offload the lateral compartment. Lateral opening-wedge distal femoral osteotomy and medial meniscal root repairs are both aimed to address the pathologic biomechanics of the tibiofemoral joint and when successful can delay or even prevent progression to end-stage osteoarthritic changes in the lateral and medial compartment, respectively. Indications: Distal femoral osteotomy is indicated for patients with normal metabolic bone health and valgus malalignment who may present with concurrent lateral meniscal injury, symptomatic lateral compartment arthritis, or a chronic medial collateral ligament tear/laxity. Technique Description: Long-leg alignment radiographs and preoperative magnetic resonance images are required to evaluate the degree of mechanical access deviation and to evaluate for soft tissue injury, as there is often concomitant lateral meniscal or cartilage pathology present. This technique demonstrates the optimal order of surgical steps for DFO with a concurrent medial meniscal root repair. The senior author’s preferred order is to first perform the open lateral approach and expose the lateral cortex for the placement of plate prior to arthroscopic work and excess fluid extravasation. Intra-articular work is then performed with a diagnostic arthroscopy followed by medial meniscal root repair. Finally, the osteotomy and subsequent internal fixation are performed. Results: The literature on opening-wedge DFO outcomes is heterogeneous, with variable rates of successful outcomes and complications. Saithna et al reported that International Knee Documentation Committee and the pain subdomain of Knee injury and Osteoarthritis Outcome Scores significantly improved postoperatively following lateral opening-wedge DFOs in patients with lateral compartment osteoarthritis. The 10-year success rate of varus-producing DFO has been reported to be 64% to 85%. Discussion: We describe a technique for correction of a valgus deformity with opening-wedge DFO and concurrent meniscal root repair. This surgical technique effectively restores the native femoral and tibial axis with appropriate load distribution and also concurrently restores the appropriate function of the medial meniscus which allows axial force dispersion via hoop stresses for the medial compartment. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Modified Bosworth Technique for Medial Collateral Ligament Reconstruction of the Knee Using Semitendinosus Tendon Autograft

The medial collateral ligament (MCL) is a major contributor to knee joint stability and is the most common ligament involved in knee injuries. When conservative management for high-grade MCL injuries fails, operative treatment is indicated. Various reconstruction techniques are described in the literature. The following report describes a reconstruction technique based on the modified Bosworth. We present a step-by-step technique for using autograft semitendinosus tendon as a double limb to reconstruct the MCL and if necessary, the posterior oblique ligament. The technique is versatile with respect to a spectrum of MCL injury patterns, isometric, incorporates techniques that are common to other knee reconstructions, and uses readily available autograft. It has been used extensively by the senior authors as an adjunct/augmentation to the repair of acute MCL injuries as well as in the reconstruction of chronic MCL laxity. The technique restores stability to rotation and valgus stress while maintaining the distal insertion of the semitendinosus intact.

Single-Row Repair in Chronic Medial Collateral Ligament Insufficiency

AbstractMedial collateral ligament (MCL) is the most commonly injured ligament of the knee. Acute Grade III MCL injuries can be managed conservatively except bony avulsion, intra-articular entrapment and Stener lesion, which requires surgical treatment by repair with or without augmentation. Chronic MCL injuries are treated surgically with various reconstruction techniques that are well established in the literature, which requires use of autograft or allograft and multiple tunnel placement with multiple implants for graft fixation. These techniques possess higher chances of tunnel convergence and hardware-related complications, further increasing surgery cost, especially for multi ligament injuries. Finally, all these MCL reconstruction surgeries are technically challenging. Here, we propose our technique of single-row repair in cases of chronic femoral side MCL insufficiency with grade III valgus laxity. This technique reattaches the torn ligament at its near anatomical attachment site using a single, double-loaded 5.5-mm suture anchor. This technique preserves and uses the native MCL, requiring no separate graft and no tunnel preparation. Hence, no graft site morbidity and tunnel-related complications, along with maintenance of proprioception. It is a cost-effective, reproducible, and technically simple procedure with good functional outcome. Level Iknee Level IIcollateral ligaments

Chronic Medial Collateral Ligament Sprain Treated With Percutaneous Ultrasonic Debridement: A Case Report

The medial collateral ligament (MCL) is the most commonly injured ligament of the knee. Most grade I and II injuries respond to conservative management, but symptoms persist in some patients. In these cases, treatment options are limited. Percutaneous ultrasonic debridement is increasingly being used for tendinopathy and fasciopathy refractory to conservative management, but this has not been reported as a treatment for ligament injury. Here, we present a case of a chronic grade II MCL sprain successfully treated with percutaneous ultrasonic debridement.

Chronic Medial Collateral Ligament Sprain and Medial Collateral Ligament Bursitis of the Knee in a Female Soccer Player: A Case Report

Chronic Medial Collateral Ligament Sprain and Medial Collateral Ligament Bursitis of the Knee in a Female Soccer Player: A Case Report

Distal Femoral Varus Osteotomy for the Management of Valgus Deformity of the Knee.

Distal femoral varus osteotomy is a well-described treatment option for patients with valgus malalignment associated with a variety of underlying conditions. This procedure may be the definitive treatment option in active patients with isolated lateral compartment osteoarthritis or posttraumatic arthritis. It may be a useful concomitant procedure in young patients with lateral meniscus deficiency, focal chondral defects, chronic medial collateral ligament insufficiency, and/or patellofemoral instability. Distal femoral varus osteotomy can be performed with medial closing wedge or lateral opening wedge techniques. Variable outcomes and complication rates have been reported. A framework for the use of distal femoral varus osteotomy can aid the orthopaedic surgeon in the evaluation and treatment of patients with symptomatic valgus malalignment.

Simultaneous Reconstruction of the Medial and Lateral Collateral Ligaments for Chronic Combined Ligament Injuries of the Ankle

Background: Objective data on chronic injuries of the medial collateral ligament (MCL) of the ankle are scarce. Chronic MCL injuries are frequently associated with lateral collateral ligament (LCL) injuries. For patients with chronic combined MCL and LCL injuries, the authors have performed simultaneous surgery of the 2 ligaments. Hypothesis: Simultaneous surgery of the 2 ligaments may be effectively used to treat chronic combined MCL and LCL injuries. Study Design: Case series; Level of evidence, 4. Methods: Surgical outcomes were evaluated in 29 consecutive patients presenting with chronic MCL and LCL injuries (30 ankles; 15 men and 14 women; mean age, 31 years; 13 competitive and 10 recreational athletes). Preoperative and postoperative clinical outcomes were measured with the Karlsson score and the Japanese Society for Surgery of the Foot (JSSF) ankle-hindfoot scale score. The patients underwent preoperative and postoperative functional measurements and a radiological examination. In addition, preoperative magnetic resonance imaging (MRI) results, arthroscopic findings, and histology of the MCL were evaluated. Results: Preoperatively, the deep fibers of the MCL did not appear striated in 29 ankles, and high-intensity signal changes were observed in 23 ankles on T2-weighted or gradient echo MRI. MCL ruptures were confirmed with arthroscopic surgery. Medial impingement lesions and focal chondral lesions were confirmed in 10 and 21 ankles, respectively. Histology of the reconstructed MCL showed dense collagen fibers with vessels. The mean postoperative follow-up period was 30 months (range, 24-52 months). There was a significant change between preoperative and postoperative Karlsson scores (69.0 vs 96.1 points, respectively; P < .0001) and JSSF scores (69.8 vs 94.5 points, respectively; P < .0001). On varus and valgus stress radiography, the postoperative talar tilt angle was significantly lower than the preoperative angle. Postoperative anterior displacement on stress radiography was significantly lower than preoperative anterior displacement. Postoperatively, all 23 athletes returned to their preinjury level of sports participation. Conclusion: MCL insufficiency resulted from medial ankle instability and medial impingement lesions. Outcomes in the patients indicated that MCL reconstruction or resection of medial impingement lesions, performed in addition to LCL reconstruction, is effective for treating chronic combined MCL and LCL injuries of the ankle.

The anatomy of the medial collateral ligament of the knee and its significance in joint stability

The medial collateral ligament (MCL) is the most important stabilizer of the medial side of the knee together with the capsuloligamentous complex. As such, it has a distinctive role in joint stability, as far as its biomechanics are concerned, and major joint stability issues onset when it is injured or deficient. One of the main functions of the medial collateral ligament is mechanical as it passively stabilizes the knee and help in guiding it through its normal range of motion when a tensile load is applied. It exhibits nonlinear anisotropic mechanical behaviour, like all ligaments, and under low loading conditions it is relatively compliant, perhaps due to recruitment of “crimped” collagen fibres as well as to viscoelastic behaviours and interactions of collagen and other matrix materials. Continued ligament-loading results in increasing stiffness until a stage is reached where it exhibits nearly linear stiffness and beyond this it continues to absorb energy until it is disrupted. In addition, the function of the MCL has to do with its viscoelasticity which assists the maintainance of joint congruity and homeostasis. The treatment of grade III medial collateral ligament injuries (with gross valgus instability at 0° of flexion) is still controversial. The most severe injuries (especially with severe valgus alignment, intra-articular medial collateral ligament entrapment, large bony avulsions, or multiple ligament involvement) may require acute operative repair or augmentation. In addition, surgical reconstruction is indicated for isolated symptomatic chronic medial collateral ligament laxity. The optimal surgical treatment remains controversial. More studies with evidence of level I and II are required in order to clarify the pros and cons of any solution.

Dynamic Valgus Instability of the Knee due to Chronic Medical Collateral Ligament Laxity as a Cause of Recurrent Patella Dislocation

Recurrent patella dislocation can be caused by bony abnormalities, such as patella alta, increased tibial tubercle lateralization, trochlea dysplasia, excessive femoral neck anteversion and external tibial torsion. It can also be caused by soft tissue abnormalities such as a ruptured medial patellofemoral ligament (MPFL) or a weak vastus medialis obliquus. It has been reported in the literature that acute lateral dislocation of the patella can be associated with proximal injury to the medial collateral ligament (MCL). This article reports the case of a 26-year-old male pro footballer who had recurrent patella dislocation related to previous injury to his MPFL and worsened by dynamic valgus knee instability due to chronic MCL insufficiency.

Surgical Treatment of Subacute and Chronic Valgus Instability in Multiligament-Injured Knees With Superficial Medial Collateral Ligament Reconstruction Using Achilles Allografts

Background: Symptomatic medial collateral ligament (MCL) instability is rare, and it is frequently associated with multiligament injuries. Most clinical investigations have failed to clearly define the specific objective outcome measures assessing the stability of the MCL quantitatively before and after the reconstruction procedure. Purpose: To quantitatively evaluate the early clinical outcomes of patients with valgus instability of knee joints who had undergone superficial MCL reconstruction using Achilles tendon allografts. Study Design: Case series; Level of evidence, 4. Methods: From August 2005 to December 2010, 19 consecutive patients with MCL injuries were included in this study. The inclusion criteria were (1) a subacute or chronic MCL injury, with a time from initial injury to surgery of longer than 3 weeks, and (2) valgus laxity graded C or D according to the International Knee Documentation Committee (IKDC). All patients underwent superficial MCL reconstruction using Achilles tendon allografts. To evaluate the laxity of the MCL preoperatively and postoperatively, valgus stress radiographs using a Telos device were used. Other assessments included the IKDC subjective functional evaluation and Lysholm score estimation. Results: Sixteen of the 19 patients (12 men and 4 women) were available for final follow-up. The median age of the patients was 37 years (range, 19-53 years); mean body mass index (BMI) was 26.4 (range, 21.7-29.4). The mean time from injury to surgery was 15.9 months (range, 24 days to 84 months), and median follow-up period was 34 months (range, 24-67 months). The mean medial knee laxity (side-to-side difference) was 8.9 ± 3.2 mm (range, 6-15.9 mm) preoperatively and 1.1 ± 0.9 mm (range, –1.1 to 3.2 mm) postoperatively (P < .001). The preoperative mean IKDC subjective knee functional score was 49.8 ± 6.9 (range, 31-57.5), while the postoperative functional score was 84.3 ± 6.0 (range, 71.3-93.1) (P < .001). The mean Lysholm score was 69.3 ± 5.9 (range, 55-78) preoperatively and 88.6 ± 5.0 (range, 75-95) postoperatively (P < .001). There was no significant correlation between patients’ BMI and the final clinical outcome scores (P = .311). Conclusion: In a small set of patients with multiligament-injured knees, valgus laxity can be effectively restored through surgical management with superficial MCL reconstruction, when the other associated ligament injuries are reconstructed as well. The subjective functional results were significantly improved postoperatively at short-term follow-up.

Anatomical Reconstruction of the Medial Collateral Ligament and Posteromedial Corner of the Knee in Patients With Chronic Medial Collateral Ligament Instability

Anatomical Reconstruction of the Medial Collateral Ligament and Posteromedial Corner of the Knee in Patients With Chronic Medial Collateral Ligament Instability

How Isometric Are the Medial Patellofemoral, Superficial Medial Collateral, and Lateral Collateral Ligaments of the Knee?

Background Ligament isometry is a cornerstone in the description of normal knee function and thorough knowledge is mandatory for successful repair of torn ligaments. Purpose This study was undertaken to validate a novel experimental model for the study of ligament strains and to determine the length changes in the superficial medial collateral, lateral collateral, and medial patellofemoral ligaments. Study Design Descriptive laboratory study. Methods Passive motions and loaded squats of 12 cadaveric specimens were performed while controlling ankle load and optically tracking the motion of the bones. Preexperiment and postexperiment computed axial tomography scans allow the transformation of rigid body motion to relative motion of relevant anatomic landmarks on the femur, tibia, and patella. Results The superficial medial collateral ligament is a near-isometric ligament with a strain of less than 2%. The ligament is a little more slack in midflexion (30° to 50°) and in deep flexion, but length changes are not significant (P > .05). The lateral collateral ligament behaves near isometric (<2% strain) from 0° to 70° of knee flexion. Cartilage compression in a loaded environment relieves tension from the collateral ligaments (P < .05). The medial patellofemoral ligament is nonisometric. The cranial part of the medial patellofemoral ligament is most taut at full extension, while the caudal part is most taut at 30° of knee flexion. Conclusion Ligament insertion sites on the femur, patella, and fibula can be derived from computed axial tomography scans. The described model allows the study of dynamic ligament behavior. The superficial medial collateral ligament is a near-isometric ligament with no significant length changes. The medial patellofemoral ligament behaves differently in its cranial and caudal parts. Clinical Relevance In knees with chronic medial collateral ligament insufficiency, isometric repair of the superficial medial collateral ligament can be attempted. A medial patellofemoral ligament reconstruction with a double fixation on the medial patellar border is supported. The cranial bundle should be tightened at full extension and the caudal bundle at 30° of knee flexion.

Anatomical Reconstruction of the Medial Collateral Ligament and Posteromedial Corner of the Knee in Patients With Chronic Medial Collateral Ligament Instability

Background In cases of multiple ligament injury or severe medial collateral ligament (MCL) lesion, nonoperative treatment of the MCL lesion may lead to chronic valgus instability or rotatory instability. Hypothesis In a retrospective case series after isolated and combined MCL reconstructions using a novel MCL reconstruction technique that addresses both the MCL and the posteromedial corner, an acceptable clinical outcome is expected 2 years after MCL reconstruction. Study Design Case series; Level of evidence, 4. Methods From July 2002 to December 2005, 61 patients with grade 3 or 4 medial instability were treated with MCL reconstruction. Median age was 33 years (range, 14–62). Thirteen underwent isolated MCL reconstructions, 34 had combined MCL and anterior cruciate ligament (ACL) reconstruction, and 14 had multiple ligament reconstructions. All patients had reconstruction of the medial collateral and the posteromedial complex using ipsilateral semitendinosus autografts. Fifty patients were available for follow-up more than 24 months postoperatively and were examined by an independent observer using objective International Knee Documentation Committee (IKDC) measures and subjective Knee Injury and Osteoarthritis Outcome Score (KOOS). Results At follow-up, medial stability according to the IKDC score showed 98% normal or nearly normal (grade A or B), and for overall IKDC score, patients improved from 5% with grade A or B preoperatively to 74% with grade A or B at follow-up. There were 91% who were satisfied or very satisfied with the result; 88% would go through surgery again. The KOOS improved primarily for sports and quality of life subscales with approximately 10-point improvements. Conclusion Acceptable clinical results with the MCL reconstruction technique were achieved in patients suffering from chronic valgus instability.

Isolated Anterior Cruciate Ligament Reconstruction in Patients with Chronic Anterior Cruciate Ligament Insufficiency Combined with Grade II Valgus Laxity

Background There is no consensus about whether isolated anterior cruciate ligament reconstruction using multistrand hamstring tendon with nonoperative treatment for chronic medial collateral ligament injury is sufficient. Purpose To assess clinical outcome for patients with chronic anterior cruciate ligament injury and accompanying grade II valgus laxity who received medial hamstring anterior cruciate ligament reconstruction alone. Results were compared with those of patients with isolated chronic anterior cruciate ligament injury without valgus laxity. Study Design Cohort study; Level of evidence, 2. Methods Two hundred eighty-nine patients with isolated anterior cruciate ligament injury were compared with 53 patients with accompanying valgus laxity (minimum follow-up, 24 months). The following parameters were compared between the 2 groups at the last follow-up: range of motion, KT-1000 arthrometer value, pivot-shift test result, Lysholm knee scale, knee extensor muscle strength, return to sporting activities, subjective recovery, and International Knee Documentation Committee grade. Differences in clinical outcome were evaluated between those with preoperative International Knee Documentation Committee grade B and grade C and between those with grade A and grade B or C at final evaluation. Results Postoperative KT-1000 arthrometer value averaged 1.2 mm for those with isolated anterior cruciate ligament injury and 1.6 mm for those with accompanying valgus laxity (not significant, P = .281). There was no significant difference between these 2 groups regarding the other items. In patients with preoperative valgus laxity, KT-1000 arthrometer values at final evaluation between patients with preoperative grade B and C were not significantly different. The value for subjects with grade A at final evaluation was 1.3 mm and for those with grade B or C at final evaluation was 2.7 mm (P = .065). Conclusion There was no clinically significant difference regarding outcome of anterior cruciate ligament multistrand hamstring reconstruction alone for 90% of patients with grade II valgus laxity who regained medial stability with nonoperative management compared with those who underwent the same anterior cruciate ligament reconstruction for an isolated anterior cruciate ligament tear.

Treatment of Chronic Injuries to the Medial Side of the Knee

ABSTRACT Chronic medial collateral ligament insufficiency is seen less commonly today because of modern-day orthopaedists' ability to recognize the acute medial injury and treat it. Failure of nonoperative or operative management is often the result of unaddressed associated injuries, including those of the posteromedial corner, meniscus, or cruciate ligaments. In patients with chronic medial instability, primary repair supplemented with appropriate reconstruction can restore stability to the knee.

Evaluation and Treatment of Chronic Medial Collateral Ligament Injuries of the Knee

Injuries to the medial collateral ligament (MCL) can occur as isolated injuries or in conjunction with injuries to other structures about the knee. Most grade I and II MCL injuries without meniscal avulsion, alone or in combination with anterior or posterior cruciate ligament injuries, can be treated nonoperatively. Grade III or complete tears also can be treated nonoperatively, but only after careful exclusion of any associated injuries that may require surgical treatment. Treatment recommendations also have been based on the location of the MCL tear and the associated injuries. Surgical treatment may include reconstruction of the anterior and posterior cruciate ligaments with primary repair of the MCL. Chronic medial knee injuries often are associated with concomitant ligament injuries, which also must be treated. Treatment options include nonoperative (bracing, activity modification, and rehabilitation) and operative reconstruction.

Paper #200 Chronic medial collateral ligament insufficient knee without cruciate ligament injury

In spite of a high healing potential of a torn medial collateral ligament (MCL), some cases show valgus instability, which is commonly combined with cruciate pathology. However, reports on chronic medial instability without any cruciate ligament injuries have not been conducted. In this study, we described the clinical features of chronic MCL insufficiency without any other ligamentous pathology, and outcomes of MCL reconstruction.

The use of a modular rotating hinge component in salvage revision total knee arthroplasty

Revision total knee arthroplasty (TKA) using a second-generation modular rotating hinge design was performed on 16 knees in 15 patients over a 5-year period. Follow-up of 2 to 6 years (mean, 51 months) was obtained in 14 knees in 13 patients. Indications for revision were aseptic loosening of a hinged prosthesis (8 knees), loosening and bone loss associated with chronic extensor mechanism disruption (2 knees), component instability with chronic medial collateral ligament disruption (3 knees), and comminuted distal femur fracture (1 knee). Clinical and radiographic results were reviewed and compared with 87 patients who underwent revision TKA using a standard condylar revision design during the same period. Early results showed comparable postoperative knee scores and range of motion between the 2 groups despite the use of the rotating hinge component in more complex revision cases. No patient has exhibited radiographic evidence of definite component loosening. Alignment of 5° to 10° of valgus in the frontal plane and within 2° of neutral in the sagittal plane was achieved consistently. Short-term clinical and radiographic results are encouraging and suggest that a second-generation modular rotating hinge component can be used successfully in selected salvage revision cases.