Medial Collateral Ligament Lesions Research Articles

Changes in the Elongation Pattern of the Medial Collateral Ligament During a Single-Leg Squat After Anterior Cruciate Ligament Reconstruction

Background: An anterior cruciate ligament (ACL) tear impairs knee biomechanics in daily activities and potentially breaks the synergy among other knee ligaments. Previous studies have demonstrated that the biomechanics of collateral ligaments is influenced by ACL deficiency. Purpose: To investigate changes in the elongation patterns of the medial collateral ligament (MCL), lateral collateral ligament (LCL), and posterior cruciate ligament (PCL) during the execution of a single-leg squat before and after ACL reconstruction. Study Design: Descriptive laboratory study. Methods: A total of 16 patients (mean age, 24.9 ± 8.5 years) with ACL deficiency were enrolled in the study. Magnetic resonance imaging scans of the affected knees were used to produce 3-dimensional models of the tibia and femur and identify insertion sites of the MCL, LCL, and PCL. Motion capture of a single-leg squat was performed through a biplanar radiographic system. Data were acquired before ACL reconstruction and at a minimum of 18 months (mean, 22.9 ± 4.1 months) postoperatively. The centroids of the ligaments’ insertions were used to calculate the length of the investigated structures during the squat task. Absolute length ( L), absolute length increase from the orthostatic resting position (Δ L), and relative length increase (Δ L%) were computed for each ligament, and preoperative and postoperative data were compared using the paired Student t test. The intraclass correlation coefficient was used to determine the reliability of the ligament insertion's identification and kinematics between 2 independent observers. Results: Significant differences were found for the MCL in absolute length increase ( P = .047; Cohen d = 0.60) and relative length increase ( P = .043; Cohen d = 0.61) from rest between preoperatively and postoperatively (Δ Lpre = 1.0 mm; Δ Lpost = −1.1 mm; difference = 2.1 mm) at 0° to 30° of knee flexion during the descending phase of the single-leg squat. No differences were seen in the elongation patterns of the LCL or PCL from before to after ACL reconstruction. Conclusion: The MCL was significantly longer between 0° and 30° in ACL-deficient knees compared with ACL-reconstructed knees during the descending phase of a single-leg squat. No differences were identified for the LCL or PCL. Clinical Relevance: Early ACL reconstruction could have a protective effect on the MCL in combined ACL and MCL lesions.

High incidence of RAMP lesions and a nonnegligible incidence of anterolateral ligament and posterior oblique ligament rupture in acute ACL injury.

The purpose of this study was to assess the frequency of medial collateral ligament (MCL), posterior oblique ligament (POL) and anterolateral ligament (ALL) tears and different types of RAMP lesions of patients with verified acute anterior cruciate ligament (ACL) tears by magnetic resonance imaging (MRI). MRI was performed on patients with a clinical diagnosis of acute ACL injury. Patients were eligible for inclusion if they had an initially clinically noted ACL tear confirmed on MRI within 30 days of trauma. A total of 146 patients were included in the study, 42 (28.8%) females and 104 (71.2%) males. The mean age at MRI was 27.2 ± 9.4 years, and the mean time from injury to MRI was 15.7 ± 7.8 days. Thirty-four (23.3%) patients had a complete MCL lesion, 32 (21.9%) had a complete POL lesion and 28 (19.2%) had a complete ALL lesion. One hundred and fourteen patients (78.1%) presented with RAMP lesions, while 20 (13.7%) patients reported other meniscal lesions. The mean medial and lateral tibial slopes were 4.0° ± 2.7° and 4.0° ± 3.1°, respectively. Only 10 (6.8%) patients reported no lesions associated with ACL rupture. The most common injuries were isolated RAMP type 3 (18-12.3%) and isolated RAMP type 1 (17-11.6%). Thirteen (8.9%) patients had a combination of MCL, POL and ALL rupture. Isolated lesions of the ACL are extremely rare. In most cases, a single RAMP lesion should be investigated. In the presence of MCL injury, POL injury should always be suspected as well, while nearly 20% of patients present a rupture of the ALL. About one in 10 patients had three lesions (MCL, ALL and POL), and most of them had a combined RAMP lesion. Level IV.

Reconstruction of the Posterior Cruciate Ligament and Medial Collateral Ligament With a Single Combined Femoral Tunnel

Background: Lesions of the medial collateral ligament (MCL) are the most common knee ligament injuries and, when they occur in isolation, they often progress with satisfactory outcomes using conservative treatment. However, MCL lesions associated with anterior cruciate ligament or posterior cruciate ligament (PCL) injuries in knee dislocations should be reconstructed to prevent failure of the central pivot. In knees with combined injuries involving the PCL and the MCL, the confluence of tunnels in the medial femoral condyle can be a potential problem during reconstruction surgery. Indications: The indication of this technique is the combined injury of the PCL and the MCL. Technique Description: The technique consists in the reconstruction of the PCL and the MCL with an Achilles tendon allograft. The bone plug of the graft is fixed on the tibial bed with the inlay technique. The graft passes through a single femoral tunnel drilled in the medial femoral condyle, with entrance point on the footprint of the PCL on the inner wall of the condyle and exit on the origin of the native MCL, near to the medial epicondyle. The graft is fixed in the femoral tunnel with an interference screw and continues to the isometric point of the anatomic insertion of the MCL in the tibia, where an interference screw is used to fix it. Results: Results from our group using this technique have shown good clinical outcomes, with complications and failure rates similar to other series in the literature. Discussion/Conclusion: This technique is an excellent option for surgeons, when an Achilles tendon allograft is available, to avoid confluence of tunnels in the medial femoral condyle. It presents good results and acceptable complication rates, compatible with the severity of this lesion. 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.

Stener-Like Lesion of the Superficial Medial Collateral Ligament of the Knee: An Injury Not to Miss!

Stener-Like Lesion of the Superficial Medial Collateral Ligament of the Knee: An Injury Not to Miss!

Patients with knee osteoarthritis can be divided into subgroups based on tibiofemoral joint kinematics of gait – an exploratory and dynamic radiostereometric study

Patients with advanced knee osteoarthritis (KOA) frequently alter their gait patterns in an attempt to alleviate symptoms. Understanding the underlying pathomechanics and identifying KOA phenotypes are essential to improve treatments. We investigated kinematics in patients with KOA to identify subgroups of homogeneous knee joint kinematics. A total of 66 patients with symptomatic KOA scheduled for total knee arthroplasty and 15 age-matched healthy volunteers with asymptomatic, non-arthritic knees were included. We used k-means clustering to divide patients into subgroups based on dynamic radiostereometry-assessed tibiofemoral joint kinematics. Clinical characteristics such as knee ligament lesions and KOA scores were graded by magnetic resonance imaging and radiographs, respectively. We identified four clusters that were supported by clinical characteristics. The flexion group (n=20) consisted primarily of patients with medial KOA. The abduction group (n=17) consisted primarily of patients with lateral KOA. The anterior draw group (n=10) was composed of patients with medial KOA, some degree of anterior cruciate ligament lesion and the highest KOA score. The external rotation group (n=19) primarily included patients with medial collateral and posterior cruciate ligament lesions. Based on tibiofemoral gait patterns, patients with advanced KOA can be divided into four subgroups with specific clinical characteristics and different KOA-affected compartments. The findings add to our understanding of how knee kinematics may affect the patient's development of different types of KOA. This may inspire improved and more patient-specific treatment strategies in the future.

Imaging of the medial collateral ligament of the knee: a systematic review

IntroductionThe primary aim of this investigation was to systematically review relevant literature of various imaging modalities (magnetic resonance imaging (MRI), stress radiography and ultrasonography) in the assessment of patients with a medial collateral ligament (MCL) injury.Materials and methodsA systematic literature review of articles indexed in PubMed and Cochrane library was performed. Original research reporting data associated with medial gapping, surgical, and clinical findings associated with MCL injuries were considered for inclusion. The methodological quality of each inclusion was also assessed using a verified tool.ResultsTwenty-three imaging studies (magnetic resonance imaging (MRI) n = 14; ultrasonography n = 6; radiography n = 3) were ultimately included into the review. A total of 808 injured, and 294 control, knees were assessed. Interobserver reliabilities were reported in radiographic and ultrasonographic investigations with almost perfect agreement. MRI studies demonstrated agreement ranging between substantial to almost perfect. Intraobserver reliability was only reported in radiographic studies pertinent to medial gapping and was found to be almost perfect. Correlation of MRI with clinical findings was moderate to strong (65–92%). Additionally, MRI imaging was more sensitive in the detection of MCL lesions when compared to clinical examination. However, when compared to surgical findings, MRI underestimated the grade of instability in up to 21% of cases. Furthermore, MRI showed relatively inferior performance in the identification of the exact MCL-lesion location when compared to surgical findings. Interestingly, preoperative clinical examination was slightly inferior to stress radiography in the detection of MCL lesions. However, clinical testing under general anaesthesia performed similar to stress radiography. The methodological quality analysis showed a low risk of bias regarding patient selection and index testing in each imaging modality.ConclusionMRI can reliably diagnose an MCL lesion but demonstrates limitations in its ability to predict the specific lesion location or grade of MCL instability. Ultrasonography is a widely available, radiation free modality, but is rarely used in clinical practice for detecting MCL lesions and clinical or surgical correlates are scarce. Stress radiography findings correlate with surgical findings but clinical correlations are missing in the literature.Level of evidenceIV.

Ultrasound-based evaluation revealed reliable postoperative knee stability after combined acute ACL and MCL injuries

PurposeAnterior cruciate ligament (ACL) injuries are often combined with lesions of the medial collateral ligament (MCL). The aim of this study was to evaluate treatment outcome of combined acute ACL and MCL lesions using functional US and clinical examination.MethodsPatients aged > 18 years undergoing primary ACL reconstruction with concomitant operative (group 1) or non-operative treatment of the MCL (group 2) between 2014 and 2019 were included after a minimum follow-up of 12 months. Grade II MCL injuries with dislocated tibial or femoral avulsions and grade III MCL ruptures underwent ligament repair whereas grade II injuries without dislocated avulsions were treated non-operatively. Radiological outcome was assessed with functional US examinations. Medial knee joint width was determined in a supine position at 0° and 30° of knee flexion in unloaded and standardized loaded (= 15 Dekanewton) conditions using a fixation device. Clinical examination was performed and patient-reported outcomes were assessed by the use of the subjective knee form (IKDC), Lysholm score, and the Tegner activity scale.ResultsA total of 40 patients (20 per group) met inclusion criteria. Mean age of group 1 was 40 ± 12 years (60% female) with a mean follow-up of 33 ± 17 months. Group 2 showed a mean age of 33 ± 8 years (20% female) with a mean follow-up of 34 ± 15 months. Side-to-side differences in US examinations were 0.4 ± 1.5 mm (mm) in 0° and 0.4 ± 1.5 mm in 30° knee flexion in group 1, and 0.9 ± 1.1 mm in 0° and 0.5 ± 1.4 mm in 30° knee flexion in group 2, with no statistically significant differences between both groups. MCL repair resulted in lower Lysholm scores (75 ± 19 versus 86 ± 15; p < 0.05). No significant differences could be found for subjective IKDC or Tegner activity scores among the two groups.ConclusionA differentiated treatment concept in combined ACL and MCL injuries based on injury patterns leads to reliable postoperative ligamentous knee stability in US-based and clinical examinations. However, grade II and III MCL lesions with subsequent operative MCL repair (group 1) result in slightly poorer subjective outcome scores.Level of evidenceRetrospective cohort study; Level III

Клинико-ультразвуковые характеристики поражения энтезисов при воспалительных заболеваниях кишечника

Aim: to assess enthesis lesions in patients with inflammatory bowel disease/IBD (ulcerative colitis/UC and Crohn’s disease/CD) and associations between the clinical pattern of the underlying disease and enthesopathy verified by ultrasound. Patients and Methods: this study included 95 patients with IBD aged 26–37 (the mean age was 37 years). Each patient underwent clinical examination and ultrasound of the entheses of the upper and lower extremities with calculating enthesial indices. The pattern of enthesopathy in patients with UC and CD was compared. Correlations between clinical characteristics of IBD and enthesopathy were evaluated. The analysis of individual anatomical sites of tendon and ligament insertions in patients with IBD was performed for the first time. Results: pain elicited on local pressure of entheseal points was seen in 52%. Enthesitis was diagnosed through ultrasound in 76% of patients (enthesitis with vascularization in 76%, erosions at insertions in 80%, and enthesophytes in 39%). When assessing anatomical sites, the most common impairment was a medial collateral ligament lesion, while the most common localization of enthesophytes was the insertion point of the quadriceps femoris muscle. Disease duration directly correlated to the number of painful entheses on palpation (SR=0.24, р=0.017) and the number of enthesophytes (SR=0.20, р=0.044). We failed to identify any significant associations between the severity of the attack and enthesis lesions in UC and CD. Direct correlations between the number of extraintestinal manifestations and the number of painful entheses on palpation (SR=0.35, р=0.0004) and LEI (SR=0.2, р=0.04) and GUESS scores (SR=0.28, р=0.004); the number of erosions with vascularization and ESR (SR=0.26, р=0.01) and CRP (SR=0.25, р=0.01); the number of painful entheses on palpation and the number of enthesitis (SR=0.71, р=0.00) including those with vascularization (SR=0.27, р=0.00) were revealed. Conclusion: enthesopathy is a common extraintestinal manifestation of IBD independent of a nosology of the severity of the attack of the underlying disease. Greater disease duration, pain at entheses on palpation, and increased inflammatory markers (ESR, CRP) are associated with enthesis lesions. Therefore, current enthesopathy indices can be applied to assess and monitor entheses. KEYWORDS: inflammatory bowel disease, ultrasound, enthesitis, vascularization, Power Doppler imaging, enthesopathy scores. FOR CITATION: Gainullina G.R., Kirillova E.R., Odintsova A.Kh., Abdulganieva D.I. Clinical and sonographic characteristics of enthesis lesions in inflammatory bowel disease. Russian Medical Inquiry. 2021;5(6):385–390 (in Russ.). DOI: 10.32364/2587-6821-2021-5-6-385-390.

REAC neurobiological treatments in acute post-traumatic knee medial collateral ligament lesion

ObjectivePhysical traumas can lead to unconscious neuropsychical alterations, which can compromise rehabilitation result and functional recovery. Aim of this interventional study is to verify if neurobiological Radio Electric Asymmetric Conveyer (REAC) treatments Neuro Postural Optimization (NPO) and Tissue Optimization (TO) are able respectively to improve neuro psychomotor strategies and facilitate recovery process in medial collateral ligaments (MCL) lesions of the knee. Patients and methods45 healthy subjects, 32 males and 13 females, with knee MCL lesion, diagnosed with MRI or ultrasound. Within 4 days after the trauma, subjects were clinically evaluated (T0), both through medical and subjective assessments. Clinical evaluation was repeated after the REAC NPO treatment (T1) and at the end of 18 REAC TO treatments (T2) and at the 30 days follow-up (T3). ResultsIn comparison with the results commonly found in clinical practice, all REAC treated patients recovered much faster. They reported functional recovery, pain relief and joint stability, regardless of the severity of the lesion. ConclusionThe combined use of REAC NPO and TO can envisage a new rehabilitative approach, which aims not only at recovering the outcomes of the physical trauma, but also at improving the neuropsychical state that can condition the rehabilitation result.

The Mini-open Plication of Medial Collateral Ligament of the Elbow: A New Arthroscopically Assisted Technique

The stability of the medial elbow compartment is not only important for everyday life but also plays a key role in throwing gestures. Valgus stress is a fundamental part of popular sport activities (baseball, squash, tennis, and volleyball). Even the isolated medial collateral ligament (MCL) lesion might develop symptomatic medial instability, which interrupts everyday life. This instability may be symptomatic and patients may refer medial elbow pain. Several techniques for MCL treatment have been described. Most of them are reconstructions in which there are tunnels and free cylindrical grafts. The aim of our study is to describe step-by-step a new surgical procedure for minimally invasive plication of aMCL arthroscopically assisted. This procedure should be performed after 6 months of conservative treatment failure. After arthroscopic MCL laxity diagnosis, the standard bioabsorbable double-loaded anchor with high resistance sutures was inserted into the anteroinferior surface of the medial epicondyle. After adequate restraint and preparation of proximal aMCL, 2 bioresorbable sutures were passed through the ligament considering 1 to 1.5 cm of tissue to be plicated. The procedure is considered less invasive and safe in comparison with graft reconstructions of MCL.

MRI findings of Stener-like lesion of the knee: A case series with surgical correlation

PurposeTo describe the MRI findings of the “Stener-like” lesion of the knee and its distinction from simple medial collateral ligament (MCL) tear. A “Stener-like” lesion of the superficial medial collateral ligament is a tear involving the distal fibers, where the torn fibers become displaced superficial to the pes anserinus fibers, a displacement which can prevent healing. MethodsNine cases of Stener-like lesion were prospectively diagnosed on MRI. Retrospective, IRB-approved, HIPAA-compliant chart review was performed to determine correlation of surgical and MRI findings. Seven cases were surgically confirmed and are included in the series. ResultsMRI is useful in making the diagnosis of Stener-like lesions and prompting the surgeon to explore the distal MCL. Coronal MRI shows variable proximal retraction of the torn ligament. It has a lax contour and abuts the pes anserinus. The proximity of the torn ligament end to the pes can result in misdiagnosis of a partial tear. Axial images are useful to confirm position of the ligament superficial to the pes. All cases had associated tear of the deep MCL fibers, as well as sprains of the proximal superficial MCL. ConclusionsIt is important to recognize the Stener-like lesion because this lesion is usually managed surgically, while most MCL tears are managed conservatively. The presence of injury to the proximal MCL is usually present, and may be a distractor from the distal injury. Care must be taken to include the distal attachment of the sMCL on coronal MRI images.

Throwing Activities Among Neolithic Populations from the Meuse River Basin (Belgium, 4500–2500 BC) with a Focus on Adolescents

ABSTRACTThe anterior band of the medial collateral ligament (MCL) is an important stabilizer for valgus stress at the elbow. When practised intensively and repetitively, activities using overhead throwing motions can injure this ligament and its insertion. If these activities occur when the epiphyses are not yet fully fused, traction forces can result in bony detachments in the area of the MCL insertion. This study was based on commingled graves found in 16 Middle and Late Neolithic caves from Belgium. We recorded the presence of MCL lesions on 196 humeri and studied the relation between lesions, siding, and robusticity. 5.1% of the humeri displayed MCL lesions, which affected only the right robust humeri. Our results suggest a social division in throwing activities in Belgium during the Neolithic. They also suggest that throwing practice started from a young age, which invites us to re-examine the role of teenagers in prehistoric societies.

Establishment of tibial tunnel via a posterior-anterior approach for all-inside posterior cruciate ligament reconstruction: short-term outcomes

Objective To introduce a new posterior-anterior approach used to establish tibial tunnel for all-inside posterior cruciate ligament (PCL) reconstruction and evaluate its short-term therapeutic effects. Methods We retrospectively analysed the 15 patients (15 knees) with PCL injury who had been treated at Department of Orthopaedics, Zhejiang Provincial People's Hospital from January 2017 to January 2018. They were 9 men and 6 women, with a mean age of 46.3 years (from 23 to 60 years). Of them, 8 left and 7 right sides were injured. The intervals from injury to surgery averaged 33.6 days (from 4 to 120 days). Their injury was complicated with medial meniscus tear in 3 cases, lateral meniscus tear in one case, lesion of medial col-lateral ligament in 2 cases and lesion of lateral medial collateral ligament in one case. After preoperative physical examination and MRI confirmed complete PLC tear in all of them, they were treated by arthroscopic all-inside PCL reconstruction in which a new posterior-anterior approach was used to establish the tibial tunnel. Lysholm scoring and International Knee Documentation Committee (IKDC) scoring were used preoperatively and postop-eratively to evaluate the knee functions. Results Their follow-ups averaged 8.3 months (from 6 to 12 months). Operation time averaged 55 minutes (from 45 to 70 minutes). All the patients got rid of the knee instability after surgery. All their posterior drawer tests and sag signs turned to be negative. At the final fol-low-up, their range of motion of the knee ranged from 110° to 130° (average, 118°); their average IKDC score was 88.1±3.3 (from 82 to 93), significantly higher than the preoperative value (52.3±2.1) (P<0.05); their average Lysholm score was 90.6±3.1 (from 84 to 96), significantly higher than the preoperative value (43.1±2.3) (P<0.05). Conclusions This new method can avoid neurovascular damage and overcome the killer turn because it provides adequate exposure of the tibial PCL footprint and accurate placement of the tibial tunnel. It is also very convenient because the new posterior-anterior approach can be used to establish the tibial tunnel in all-inside PCL reconstruction without special tools like tibial PCL guide and retrograde drill. Its short-term clinical results have proved to be satisfactory. Key words: Posterior cruciate ligament; Arthroscopy; Wounds and injuries; Tibial tunnel

Injuries of the medial collateral ligament and spring ligament complexes

The medial collateral ligament (MCL) complex is characterized by acomplex anatomical arrangement of the individual ligamentous structures including three joints and the spring ligament complex. Biomechanically it serves as the main stabilizing structure in the ankle region against rotational and pronating forces. Lesions in the region of the MCL complex are more frequent than previously thought and like lesions of the spring ligament complex can lead to pain and instability. Athorough examination including the patient history with possible injury mechanisms often yields valuable information on the diagnosis of injuries to the MCL or spring ligament complex. In many cases these are primarily overlooked and concomitant lesions, such as fractures, syndesmotic and lateral ligament lesions frequently occur; however, the clinical assessment of stability is often primarily impossible in an acute setting. High-resolution magnetic resonance imaging (MRI) plays akey role in identifying the ligamentous components. In addition, MRI plays a supportive role in the preoperative planning before reconstruction of acute and especially chronic lesions. In most cases the surgical treatment of acute ruptures of the MCL is not indicated. Various options for treatment of acute and chronic lesions of the MCL and spring ligament complex are available including the use of free tendon grafts. Controversy exists regarding the operative treatment of MCL lesions in the case of ankle fractures. It is recommended for cases with impinging tissue in the medial gutter serving as a barrier to adequate reduction of the joint and in cases of unstable fractures after reduction.

Clinical efficacy of arthroscopic treatment with anchor fixation for Segond fractures

Objective To evaluate the clinical efficacy of arthroscopic treatment with anchor fixation for Segond fractures. Methods A total of 29 patients with Segond fractures treated with arthroscopic evaluation and anchor fixation technique between January 2011 and December 2015 were included in this retrospective case series study. There were 17 males and 12 females, with an average age of 41 years (range, 27-62 years). Among the patients with Segond fractures, there were 20 patients combined with anterior cruciate ligament (ACL) rupture, three with posterior cruciate ligament (PCL) rupture, seven with medial collateral ligament (MCL) lesion, six with lateral collateral ligament (LCL) rupture, 12 with meniscus lesion, and two with tibial plateau fracture. The time duration from injury to operation was 5-14 days (mean, 7 days). The operation time and intraoperative blood loss volume were recorded. The postoperative pain, complications, knee joint stability, and fracture healing were observed. The pain was evaluated using numerical rating scale (NRS). Drawer test, Lachman test, lateral stress test, and Lysholm scores were performed to assess the knee function before and after operation. Results The operation time was 40-125 minutes (mean, 85 minutes), and intraoperative blood loss was 10-30 ml (mean, 15 ml). All patients were followed up for 12-18 months (mean, 14 months). Two weeks after operation, the pain was not obvious, with NRS of 0-1. One patient had deep venous thrombosis one week after operation, and recovered after vascular intervention therapy. Other patients had no infection, deep vein thrombosis or other postoperative complications. The results of drawer test, Lachman test, and lateral stress test were negative in all patients, which indicated good knee joint stability. All patients were seen bone union, with the healing rate of 100%. The preoperative Lysholm scores were 35-62 points [(52.0±4.2) points] , and the scores one year after operation were 86-95 points [(91.9±1.4) points] (P<0.05). Conclusion Arthroscopic treatment with anchor fixation has advantages of minor trauma, little hemorrhage, high fracture healing rate and good function recovery, and hence is an effective surgical treatment for Segond fractures. Key words: Tibial fractures; Anterior cruciate ligament; Posterior cruciate ligament; Meniscus

Biomechanical study of the effect of platelet rich plasma on the treatment of medial collateral ligament lesion in rabbits.

To evaluate the use of platelet-rich plasma in the early stages of healing of traumatic injury of the medial collateral ligament in the knee of rabbits. Thirty rabbits were subjected to surgical lesion of the medial collateral ligament. Of these, 16 were treated with platelet-rich plasma and 14 with saline (control). After 3 and 6 weeks of treatment, 50% of the animals from each group were sacrificed, and biomechanical tests were performed on the injured ligament to compare the tensile strength between the two groups. Platelet-rich plasma significantly increased the tensile strength of the ligament in the groups treated after3 and 6 weeks. In the group treated with platelet-rich plasma vs. saline, the tensile strength values were 3192.5 ± 189.7 g/f vs. 2851.1 ± 193.1 g/f at3 weeks (p = 0.005) and 5915.6 ± 832.0 g/f vs. 4187.6 ± 512.9 g/f at 6 weeks (p = 0.0001). The use of platelet-rich plasma at the injury site accelerated ligament healing in an animal model, demonstrated by an increase in the tensile strength of the medial collateral ligament.

Anatomical Repair of Stener-like Lesion of Medial Collateral Ligament: A case Series and Technical Note.

Medial collateral ligament tears usually will be treated through non-surgical methods, but, in some cases such as those with tears at the distal insertion where the reduction could be blocked by the pes anserine tendons (Stener-like lesion), surgery will be performed. Here, we present a surgical technique in such cases. In this retrospective case series, we describe six patients diagnosed with Stener-like lesion based on clinical evaluation and imaging results. In the one-year follow-up visit, there was no complaining of pain or joint instability and full range of motion and negative valgus stress test were reported in all cases. The results showed this surgical technique is a useful and safe treatment approach in such cases.

Three-Dimensional Fast Spin-Echo Imaging without Fat Suppression of the Knee: Diagnostic Accuracy Comparison to Fat-Suppressed Imaging on 1.5T MRI.

PurposeTo evaluate the diagnostic performance of three-dimensional fast spin-echo (3D FSE-Cube) without fat suppression (NFS) for detecting knee lesions, using comparison to 3D FSE-Cube with fat suppression (FS).Materials and MethodsOne hundred twenty-four patients who underwent 1.5T knee magnetic resonance imaging (MRI) scans and 25 subsequent arthroscopic surgeries were retrospectively reviewed. Using arthroscopic results and two-dimensional images as reference standards, diagnostic performances of 3D FSE-Cube-NFS and FS imaging about lesions of ligament, meniscus, subchondral bone marrow edema (BME), and cartilage were compared. Scan parameters of 3D FSE-Cube imaging were previously optimized by a porcine knee phantom.ResultsNo significant differences were observed between detection rates of NFS and FS imaging for detecting lesions of meniscus and cartilage (p>0.05). However, NFS imaging had lower sensitivity for detection of medial collateral ligament (MCL) tears, and lower sensitivity and specificity for detection of BME lesions, compared to FS imaging (p<0.05).Conclusion3D FSE-Cube-NFS imaging showed similar diagnostic performance for detecting lesions of meniscus or cartilage compared to FS imaging, unlike MCL or BME lesions.

Return to Sports after Acute Simultaneous Reconstruction of Anterior Cruciate Ligament Injury and Grade III Medial Collateral Ligament Injury

Objectives:Combined Anterior Cruciate Ligament (ACL) injury and Medial Collateral Ligament (MCL) injury account for 20% of knee ligament lesions. Conservative treatment of MCL and surgical ACL reconstruction are generally recommended. Significant medial instability after non-surgical management of MCL can lead to ACL reconstruction failure. The optimal management for athletes with combined ACL-MCL injuries remains controversial. The purpose of this study was to analyze the functional and clinical evolution of patients who underwent combined ACL-MCL surgery and their return-to-sport level with minimum 2-years follow-up.Methods:A total of 20 athletes with acute simultaneous ACL/Grade III MCL reconstructions were treated between March 2006 and January 2014. The minimum follow-up time was 24 months. Subjective functional results (IKDC, Lysholm), range of motion, anterior-medial and rotational stability (Lachmann, Pivot Shift, valgus stress) were evaluated. The ability to return to sport (Tegner) and the level achieved was recorded.Results:All patients significantly improved functional scores and stability tests. The mean subjective IKDC score improved from 37.7 ± 12.9 (range 21-69) preoperatively to 88.21 ± 4.47 (range 80-96) postoperatively (P <0.05). The average Lysholm score was 40.44 ± 10.58 (range 27-65) preoperatively and 90.83 ± 3.38 (range 84-95) postoperatively (P <0.05). Valgus and sagittal laxity was not observed (IKDC A 92% B 8%) at final follow-up. All patients had normal/nearly normal (IKDC A or B) mobility. All patients returned to sports; 90% reached the level they had prior to the ligamentous injury. Of all competitive athletes, 66% achieved the same level of sport.Conclusion:In athletes with acute ACL-Grade III MCL lesions, an early simultaneous reconstruction can significantly improve the medial and sagittal stability of the knee. This procedure resulted in excellent functional outcomes, with return to the same level of sports in the majority of patients at short-term follow-up.

Results of a New Treatment Concept for Concomitant Lesion of Medial Collateral Ligament in Patients with Rupture of Anterior Cruciate Ligament.

Anteromedial knee injury with rupture of anterior cruciate ligament (ACL) and concomitant lesion of medial collateral ligament (MCL) is common in athletes. No standardized treatment concept can be found within the literature. This study presents results of a new treatment concept for concomitant MCL lesions in patients with ACL rupture. In this study, 67 recreational athletes with ACL injury and concomitant MCL lesion were treated according to a distinct treatment concept. Patients were classified in six different types of concomitant MCL lesion depending on grade of MCL lesion and presence of anteromedial rotatory instability (AMRI). Final classification and surgical indication were determined 6 weeks posttraumatic. All patients received ACL reconstruction. MCL was treated by surgical or conservative regime due to type of concomitant MCL lesion. International Knee Documentation Committee (IKDC), AMRI, and Lysholm scores were evaluated both preoperatively and after 6 weeks, 16 weeks, 12 months, and 18 months postoperatively. All patients could be uniquely classified and treated according to the introduced treatment concept. AMRI was verifiable in patients with grade II and III MCL lesions. All patients showed good to excellent clinical results at the follow-up examinations. In all 67 patients (100%), the findings were graded as normal or nearly normal according to the IKDC knee examination form. Lysholm score averaged 93.9 at final follow-up. The introduced treatment concept showed good results on short-term outcome and provides a sufficient treatment strategy for concomitant MCL lesions in athletes with ACL rupture.