Medial Collateral Ligament Disruption Research Articles

A study on functional outcome of radial head arthroplasty in comminuted radial head fracture

Introduction: Excision is not a suitable treatment for all comminuted fracture of the radial head. In elbow instability can be predicated, radial head arthroplasty is more effective. So the aim of this paper is to study of functional outcome of radial head arthroplasty in comminuted radial head fracture (Modified masons type III and type IV) Materials and Method: From April 2018 to April 2020, radial head arthroplasty with radial head prosthesis were performed in 30 patients. There were 12 female and 18 male with mean age of 40.3 years. Total no. of patients of right side were 16 and left side were 14. The follow-up was at 1st, 3rd, 6thmonths. Fractures of the radial head have been classified by Modified Mason classification. The indications for a radial head arthroplasty were type III fractures in 22 cases, type IV fractures in 8 cases, and comminuted radial fracture associated with disruption of the lateral collateral ligament (LCL) in 5 cases, disruption of the medial collateral ligament (MCL) in 2 cases, elbow dislocation with LCL and MCL disruption in 8, olecranon fracture in 2 cases. Patients were assessed postoperatively and on follow-up at 1st,3rd, 6th months based on Mayo Elbow Performance Index (MEPI) Score. Results: Results of the study based on MEPI score, out of 30 cases, 20 cases had excellent results, 8 cases had good results, 1 case had fair result, and 1 case had poor result. Out of 30 cases 28cases had no complications, 1 case had CRPS, and 1 case had Elbow joint stiffness. Conclusion: Radial head arthroplasty can be used successfully with most of excellent results for treatment of Comminuted radial head fracture (The Modified Mason classification type III and IV radial head fractures).

Medial Elbow Pain - Recreational Athlete

HISTORY: 22-year female recreational athlete with history of left elbow pain following a fall on outstretched arm during a running/cutting activity. She noted immediate local pain of 7/10 on VAS and swelling of the medial elbow and forearm. She was unable to fully extend the elbow. PHYSICAL EXAMINATION: Edema was noted at the medial elbow, extending into the medial forearm. Palpation of soft tissues, tendon and bony structures revealed significant point tenderness at the medial joint space and at the medial epicondyle. Limited active ROM with extension was noted due to pain. Valgus stress test was positive, with significant discomfort upon moderate loading. Due to significant pain complaints, further physical examination was suspended and clinician progressed to point-of-care ultrasound imaging of the medial elbow complex DIFFERENTIAL DIAGNOSIS: 1. Medical Collateral ligament sprain 2. Medial Collateral ligament disruption 3. Common Flexor Tendon Pathology 4. Pronator Teres Strain 5. Medial epicondyle avulsion fracture 6. Biceps tendon pathology TESTS AND RESULTS: Bilateral ultrasound Imaging of the medial elbow complex revealed disruption of the ligamentous fibers of the UCL anterior band at the joint line. A large hypoechoic gap in the UCL is present, denoting the presence of significant fluid. Gravity valgus stress loading revealed a joint gap of 0.76cm compared to 0.38cm of the uninvolved side. FINAL WORKING DIAGNOSIS: Full thickness tear of the anterior bundle of the medial collateral ligament TREATMENT AND OUTCOMES: Since the athlete did not participate in overhead throwing activities, conservative management approach was selected. ROM was limited 0-100 degrees initially to full ROM at 4 weeks post injury. Strengthening was initiated with initial emphasis on core and shoulder musculature, progressed to elbow and forearm musculature, including the flexor/pronator group as an active stabilizer against valgus forces. Patient was symptom-free at 4 months following injury, and ultrasound imaging revealed reduced valgus joint gapping. This case presentation illustrates the utility of ultrasound imaging in diagnosing MCL pathology, especially when physical examination is limited due to patient discomfort, and further illustrates the successful conservative management of a full thickness MCL tear.

Neuromuscular Recovery after Medial Collateral Ligament Disruption and Eccentric Rehabilitation Program

Medial collateral ligament (MCL) rupture of the knee joint frequently occurs during sport activities. However, the optimal rehabilitation strategy after such lesion is unknown. The aim of this study was to assess the effects of progressive eccentric rehabilitation program on neuromuscular deficits induced by MCL transection. Rats were randomized as follows: (i) control group (C, n = 10) without any surgery; (ii) lesion groups in which neuromuscular measurements were made 1 (L1, n = 10) and 3 wk (L3, n = 9) after MCL transection by a 15- to 20-min surgery (this group was designed to determine changes induced by the MCL transection); and (iii) eccentric group (ECC, n = 7) in which rats performed a progressive 2-wk eccentric rehabilitation program beginning 1 wk after MCL transection surgery. Dynamic functional assessments were performed at weeks 1 and 3 after the MCL transection by measuring the maximal and minimal knee angles during the stance phase of the gait cycle. Neuromuscular measurements included 1) modulation of H-reflex in response to a 10-mM KCl injection, 2) analysis of the twitch relaxation properties of the quadriceps muscle, and 3) recording of metabosensitive and mechanosensitive afferents activity in response to chemical injections and to tendon patellar vibrations, respectively. Our results indicated that H-reflex modulation induced by metabosensitive afferents was disturbed by MCL transection without any recovery despite rehabilitation program. Responses of both metabosensitive and mechanosensitive muscle afferents, as well as the muscle relaxation properties, were fully recovered after the eccentric rehabilitation program. Our results directly indicated an influence of progressive eccentric program on muscle afferents response after MCL section but apparently not for spinal reflex modulation.

Neuromuscular recovery pattern after medial collateral ligament disruption in rats

The medial collateral ligament (MCL) is one of the most injured ligaments during sport activities. The resulting joint damage effects on neuromuscular system remain unclear. Thus this study was designed to assess the changes in neuromuscular properties of vastus medialis muscle after MCL transection. Complete rupture of MCL was performed on rats, and dynamic functional assessment during locomotion was achieved before and once a week from 1-5 wk postlesion. Twitch properties and metabo- and mechanosensitive afferent fiber responses to specific stimuli were measured 1, 3, and 5 wk after MCL transection. Results indicated that maximum knee angle measured during the stance phase of the gait cycle was decreased during 3 wk after MCL injury and then recovered. Minimum knee angle measured during the stance phase was decreased during 2 wk and showed compensatory effects at week 5. A stepwise decrease in maximum relaxation rate-to-amplitude ratio concomitant with a stepwise increase in half-relaxation time were observed following MCL injury. Variations in metabosensitive afferent response to chemical (KCl and lactic acid) injections were decreased at week 1 and recovered progressively from week 3 to week 5 postlesion. Recovery of the mechanosensitive afferent response to vibrations was not totally complete after 5 wk. Our data indicate that alteration of the sensory pathways from the vastus medialis muscle could be considered as a source of neuromuscular deficits following MCL transection. Our results should be helpful in clinical purpose to improve the knowledge of the influence exerted by ligament rupture on the motor system and permit development of rehabilitation protocols and exercises more appropriate for recovery of functional stability.

Medial Collateral Ligament Injuries and Subsequent Load on the Anterior Cruciate Ligament

Background Numerous studies have documented the effect of complete medial collateral ligament injury on anterior cruciate ligament loads; few have addressed how partial medial collateral ligament disruption affects knee kinematics. Purpose To determine knee kinematics and subsequent change in anterior cruciate ligament load in a partial and complete medial collateral ligament injury model. Study Design Controlled laboratory study. Methods Ten human cadaveric knees were sequentially tested by a robot with the medial collateral ligament intact, in a partial injury model, and in a complete injury model with a universal force-moment sensor measuring system. Tibial translation, rotation, and anterior cruciate ligament load were measured under 3 conditions: anterior load (125 N), valgus load (10 N·m), and internal-external rotation torque (4 N·m; all at 0° and 30° of flexion). Results Anterior and posterior translation did not statistically increase with a partial or complete medial collateral ligament injury at 0° and 30° of flexion. In response to a 125 N anterior load, at 0°, the anterior cruciate ligament load increased 8.7% (from 99.5 to 108.2 N; P =. 006) in the partial injury and 18.3% (117.7 N; P <. 001) in the complete injury; at 30°, anterior cruciate ligament load was increased 12.3% (from 101.7 to 114.2 N; P =. 001) in the partial injury and 20.6% (122.7 N; P <. 001) in the complete injury. In response to valgus torque (10 N·m) at 30°, anterior cruciate ligament load was increased 55.3% (30.4 to 47.2 N; P =. 044) in the partial injury model and 185% (86.8 N; P =. 001) in the complete injury model. In response to internal rotation torque (4 N·m) at 30°, anterior cruciate ligament load was increased 29.3% (27.6 to 35.7 N; P =. 001) in the partial injury model and 65.2% (45.6 N; P <. 001) in the complete injury model. The amount of internal rotation at 30° of flexion was significantly increased in the complete injury model (22.8°) versus the intact state (19.5°; P <. 001). Conclusion Partial and complete medial collateral ligament tears significantly increased the load on the anterior cruciate ligament. In a partial tear, the resultant load on the anterior cruciate ligament was increased at 30° of flexion and with valgus load and internal rotation torque. Clinical Relevance Patients may need to be protected from valgus and internal rotation forces after anterior cruciate ligament reconstruction in the setting of a concomitant partial medial collateral ligament tear. This information may help clinicians understand the importance of partial injuries of the medial collateral ligament with a combined anterior cruciate ligament injury complex.

Posterior dislocation of the elbow associated with fracture of the radial head and olecranon, and with medial collateral ligament disruption: A case report

IntroductionFracture dislocations of the elbow appear extremely complex. Identification of the basic injury patterns can facilitate management.Case presentationA 38-year-old male motor-vehicle driver who fell on his right elbow after an accident was suffering from posterior dislocation of the elbow, without coronoid fracture, and with fracture of the radial head and olecranon, and medial collateral ligament disruption, which was not associated with any vascular or neural injury.ConclusionPosterior dislocation of the elbow associated with fracture of the radial head and olecranon, and medial collateral ligament disruption may be a rare subgroup of elbow dislocation. We should pay more attention to medial collateral ligament injury with elbow dislocation.

Evolution of the rotating hinge for complex total knee arthroplasty.

Initial rotating hinge total knee designs were associated with a high failure rate. More recent designs have improved the patellofemoral articulation and the rotating hinge mechanism, added modular canal filling slotted fluted stems and metaphyseal sleeves, and improved the articulation between the mobile-bearing element and the tibial component. A series of patients with complex problems was studied. They underwent knee arthroplasty using a second generation rotating hinge component incorporating the design features listed above. Indications for surgery included medial collateral ligament disruption, revision of a previous hinged component with a massive bone loss, comminuted distal femur fracture or distal femoral nonunion in elderly patients, extensor mechanism disruption requiring reconstruction in an unstable knee, and ankylosis requiring femoral peel exposure with moderate residual flexion extension gap imbalance. A series of 23 knees in 22 patients was evaluated at the 2- to 9-year followup. The clinical results, range of motion, and satisfaction were comparable with that of a standard condylar revision knee arthroplasty despite the fact that the cases were more complex. These results warrant continued investigation of the role of rotating hinge in complex total knee arthroplasty.

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.

Postoperative return of motion in anterior cruciate ligament and medial collateral ligament injuries. The effect of medial collateral ligament rupture location.

Twenty consecutive patients with combined anterior cruciate/medial collateral ligament injuries were analyzed to determine if a correlation exists between the location of medial collateral ligament disruption and postoperative return of motion. All patients were treated operatively by autogenous patellar tendon anterior cruciate ligament reconstruction and primary medial collateral ligament repair. The mean followup was 379 days. The patients (12 men and 8 women; mean age, 23 years) were divided into two groups based on the location of superficial medial collateral ligament rupture. Group P consisted of 13 patients with lesions at or proximal to the joint line; Group D consisted of 7 patients with disruptions distal to the joint line. Group D patients had a more rapid return of motion for both flexion and extension. At the conclusion of followup, patients from Group D also achieved 8 degrees more flexion and 3 degrees more extension. There were eight additional procedures performed on five patients, all from Group P, required to treat difficulty regaining motion. Among these patients with anterior cruciate/medial collateral ligament injuries there are two distinct groups, each with different prognoses related to return of motion based on the location of the medial collateral ligament disruption. We suggest that patients with double-ligament injuries, where the medial collateral ligament lesion is proximal, should be managed very aggressively to regain motion.

Valgus Stability of the Elbow

The stabilizing structures of the elbow that resist valgus stress were studied with a tracking device in a model simulating active motion and muscle activity. By varying the order of serial release of the medial collateral ligament complex and removal of the radial head, each structure's contribution to valgus stability against the effect of gravity was determined. In the otherwise intact elbow, absence of the radial head does not significantly alter the three-dimensional characteristics of motion in the elbow joint. Isolated medial collateral release, on the other hand, causes increases in abduction rotation of about 6 degrees-8 degrees in magnitude. Releasing both structures results in gross abduction laxity and elbow subluxation. This study defines the medial collateral ligament (MCL) as the primary constraint of the elbow joint to valgus stress and the radial head as a secondary constraint. This definition facilitates the proper management of patients with radial head fractures and MCL disruption. The comminuted radial head fracture uncomplicated by MCL insufficiency should be treated by excision without the need for an implant and without concern of altering the normal kinematics of the elbow.