Medial Collateral Ligament Research Articles

Association Between Insufficient Restoration of Meniscal Tension During Surgical Repair of Medial Meniscus Root Tear and Surgical Outcomes: Clinical Implication of Curtain-Cliff Sign.

Despite the clinical benefits over nonoperative treatment or meniscectomy, the clinical outcomes of surgical repair for medial meniscus posterior root tear (MMRT) remain suboptimal, which may be attributed to the insufficient restoration of meniscal hoop tension during surgery. To analyze the clinical outcomes of surgical repair of MMRT based on the appearance of the meniscal tension observed immediately after surgery. Cohort study; Level of evidence, 3. Electronic medical records of patients who underwent arthroscopic transtibial pull-out repair of MMRT between 2010 and 2021 were retrospectively reviewed. Patients with at least a 2-year follow-up and whose overall meniscal status after the surgical repair could be evaluated via arthroscopic images or videos were eligible to be included. Patients were classified based on the presence of the curtain-cliff sign, potentially implying insufficient postoperative meniscal hoop tension (group 1, patients without the curtain-cliff sign; group 2, patients with the curtain-cliff sign). Regression analysis was performed to evaluate whether the curtain-cliff sign reflects postoperative meniscal extrusion. Subsequently, comparative analyses were conducted between the 2 groups regarding baseline demographic data, clinical scores, intraoperative data, and radiologic parameters. A total of 79 patients were included (group 1, 59 patients; group 2, 20 patients). Regression analysis revealed a significant association between the curtain-cliff sign and postoperative meniscal extrusion, suggesting its potential to reflect the postoperative meniscal tension. In the between-group comparisons, there were no differences in baseline demographic data, preoperative clinical scores, and preoperative radiologic variables. However, at the final follow-up, group 2 showed a significantly lower International Knee Documentation Committee subjective score compared with group 1 (group 1, 61.7 ± 14.4; group 2, 52.9 ± 12.5; P = .017), while no significant differences were found in the visual analog scale for pain score and Lysholm score. Additionally, group 2 exhibited significantly higher postoperative meniscal extrusion compared with group 1, which was measured at both the midpoint of the medial femoral condyle (group 1, 4.0 ± 1.1 mm; group 2, 5.1 ± 1.5 mm, P = .004) and the posterior border of the medial collateral ligament (group 1, 4.4 ± 1.2 mm; group 2, 5.7 ± 1.5 mm; P = .004), with more pronounced progression compared with the preoperative status at these sites. Consistently, the progression of both the osteoarthritis grade and the hip-knee-ankle angle compared with preoperatively was significantly greater in group 2. In patients in whom the restoration of meniscal tension appears insufficient immediately after surgical repair of MMRT, relatively poor clinical outcomes can be anticipated. The findings of this study suggest that efforts to reinforce meniscal tension may be required during surgical repair of MMRT in some cases, especially those showing the curtain-cliff sign.

DOES A NOVEL INTRAOPERATIVE NAVIGATION PLATFORM ALLOW TO RETAIN NATIVE KNEE FUNCTION FOLLOWING TOTAL KNEE ARTHROPLASTY?

IntroductionThis study aimed to evaluate the effectiveness of a novel intraoperative navigation platform for total knee arthroplasty (TKA) in restoring native knee joint kinematics and strains in the medial collateral ligament (MCL) and lateral collateral ligament (LCL) during squatting motions.MethodSix cadaver lower limbs underwent computed tomography scans to design patient-specific guides. Using these scans, bony landmarks and virtual single-line collateral ligaments were identified to provide intraoperative real-time feedback, aided in bone resection, implant alignment, tibiofemoral kinematics, and collateral ligament elongations, using the navigation platform. The specimens were subjected to squatting (35°-100°) motions on a physiological ex vivo knee simulator, maintaining a constant 110N vertical ankle load regulated by active quadriceps and bilateral hamstring actuators. Subsequently, each knee underwent a medially-stabilized TKA using the mechanical alignment technique, followed by a retest under the same conditions used preoperatively. Using a dedicated wand, MCL and LCL insertions—anterior, middle, and posterior bundles—were identified in relation to bone-pin markers. The knee kinematics and collateral ligament strains were analyzed from 3D marker trajectories captured by a six-camera optical system.ResultBoth native and TKA conditions demonstrated similar patterns in tibial valgus orientation (Root Mean Square Error (RMSE=1.7°), patellar flexion (RMSE=1.2°), abduction (RMSE=0.5°), and rotation (RMSE=0.4°) during squatting (p>0.13). However, a significant difference was found in tibial internal rotation between 35° and 61° (p<0.045, RMSE=3.3°). MCL strains in anterior (RMSE=1.5%), middle (RMSE=0.8%), and posterior (RMSE=0.8%) bundles closely matched in both conditions, showing no statistical differences (p>0.05). Conversely, LCL strain across all bundles (RMSE<4.6%) exhibited significant differences from mid to deep flexion (p<0.048).ConclusionThe novel intraoperative navigation platform not only aims to achieve planned knee alignment but also assists in restoring native knee kinematics and collateral ligament behavior through real-time feedback.AcknowledgmentThis study was funded by Medacta International (Castel San Pietro, Switzerland).

The In-Vivo Medial and Lateral Collateral Elongation Correlated with Knee Functional Score and Joint Space Following Unicompartmental Knee Arthroplasty.

The medial collateral ligament (MCL) and lateral collateral ligament (LCL) are paramount for joint stability. Their elongation patterns may change during fixed-bearing and mobile-bearing unicompartmental knee arthroplasty (FB and MB UKA). This study aims to explore the relationship between the elongation of MCL, LCL, and changes in joint space, as well as their correlation with functional scale scores during FB and MB UKA. We hypothesize that MCL and LCL have different elongation patterns in UKA patients, and there is a correlation between elongation and joint space and functional scores. The study recruited 24 patients undergoing UKA on a unilateral knee (13 FB and 11 MB). A dual fluoroscopic imaging system was employed to assess in-vivo knee kinematics during static standing and single-leg lunge. The superficial and deep MCL (sMCL, dMCL) and LCL were divided into anterior, medium, and posterior portions. The virtual ligament method quantified in-vivo ligament lengths. Analysis focused on the correlation of normalized ligament lengths with functional scores and joint space. 1. LCL Elongation in FB UKA: There is a significant increase in LCL elongation during early and mid-flexion of the single-leg lunge (p < 0.05). 2. MCL Elongation in MB UKA: Both sMCL and dMCL exhibit significant elongation during early and mid-flexion of the single-leg lunge (p < 0.05). 3. Correlation with Functional Scores: Differences in collateral ligament elongation in FB UKA are significantly correlated with the OKS and KSS, highlighting the impact on functional outcomes. In MB UKA, differences in ligament elongation are significantly correlated with the FJS. 4. Joint Space Correlation: There is a significant correlation between the elongation of the anterior and medium portions of dMCL and joint space in the surgical compartment during mid- and deep flexion (30-100 °, p < 0.05, r > 0.64). The study reveals distinct ligament elongation patterns between UKA and native knees in LCL for FB UKA and MCL for MB UKA. These patterns are associated with knee functional scores. Moreover, dMCL elongation correlates significantly with the joint space for MB UKA during middle and deep flexion phases. III; prospective retrospective cohort study.

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

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. 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. Descriptive laboratory study. 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 (ΔL), and relative length increase (ΔL%) 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. 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 (ΔL pre = 1.0 mm; ΔL post = -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. 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. Early ACL reconstruction could have a protective effect on the MCL in combined ACL and MCL lesions.

MCL pie crusting for concomitant medial meniscal surgery does not appear to adversely influence primary ACL reconstruction functional outcomes

Medial collateral ligament "pie-crusting" (MCLPC), selective release of the superficial MCL, has been shown to improve the arthroscopic access to the posterior horn of the medial meniscus without adversely affecting the outcomes of isolated meniscal surgery. However, whether MCL PC, to address concomitant meniscal lesions during anterior cruciate ligament reconstruction (ACLR) surgery, adversely affects ACLR outcomes is unknown. The aim of this study was to assess whether patients who had undergone MCLPC at the time of ACLR had similar post outcomes to patients undergoing isolated ACLR. 55 consecutive patients (33 male and 22 female), with minimum 2-year follow-up, who had undergone MCLPC with concomitant primary ACLR (PC group) were retrospectively matched on the basis of age, sex and follow-up with 55 patients who underwent isolated primary ACLR. Post-operative outcome measures (PROMs) included the Knee injury and Osteoarthritis Outcome Score, the International Knee Documentation Committee score, Tegner activity score, the EuroQol five-dimension health questionnaire and EuroQol visual analogue scale. The two groups' median postoperative EQ 5D-VAS, EQ 5D-index and Tegner scores were similar. The difference between pre-operative and post-operative KOOS scores was similar for the two group for all subscales except the ADL subscale which was higher in the MCLPC group (24, IQR= 6-32) than in the isolated ACLR group (5, IQR= 0-9.74). The median post op IKDC score was 84 in the MCLPC group and compared with 90 in the isolated ACLR group. However, the difference between pre-operative and post-operative IKDC scores was higher in patients in the MCLPC group (40, IQR= 25-49) than in the isolated ACLR group (32, IQR=19.6-46.8). MCLPC, performed at the time of ACLR does not appear to adversely affect the functional post-operative outcomes. IV.

Early Surgical Intervention Results in Better Patient-Reported Outcomes Than Delayed Treatment in Patients Undergoing Anterior Cruciate Ligament Reconstruction in the Presence of Concomitant Medial Collateral Ligament Injury

PurposeTo investigate the influence of the timing of ACL reconstruction (ACLR) on patient-reported outcomes, comparing those with and without concomitant medial collateral ligament (MCL) injury. MethodsThis study included patients who underwent ACLR between September 2015 and October 2020. Inclusion criteria required patients to have preoperative and postoperative patient-reported outcome measures (PROMs) and a follow-up period of at least 2 years. Patients who sustained a grade 2 or 3 MCL injury with an ACL tear were compared to patients with no MCL injury as a control. All patients underwent ACL reconstruction using either bone-tendon-bone (BTB) autograft or BTB Allograft. Patient-reported outcomes (International Knee Documentation Committee (IKDC), Lysholm, and Knee Osteoarthritis and Score (KOOS)) were recorded, and outcomes were analyzed by sex and time from index injury. A stratified linear mixed-effects regression analysis was conducted. ResultsA total of 253 eligible patients with 2-year outcomes were enrolled. Combined ACL/MCL injury had lower IKDC (β=-6.1 vs β=-8.3, p=0.003), KOOS QOL (β=-9.3 vs β=-11, p=0.004), and KOOS Sport (β=-12 vs β=-13 , p=0.08) if performed after 6 weeks from index injury. Isolated ACL injuries showed lower KOOS ADL (β=-2.4, p=0.045) if surgery performed between 3-6 months. For combined ACL/MCL injury, autograft (compared to allograft) was found to have worse IKDC (β=-11 (-18, -4.2), p=0.002), Lysholm (β=-9.2 (-15, -3.1), p=0.004), KOOS QOL(β=-11 (-20, -1.6), p=0.023), KOOS Pain (β=-5.1 (-10, -0.03), p=0.049), KOOS Symptoms (β=-7.6 (-10, -0.03), p=0.02), and KOOS Sports (β=-21 (-32, -10), p=<0.001). ConclusionPatients undergoing ACL reconstruction with a grade 2 or 3 MCL injury have improved patient-reported outcomes if surgery is performed within 6 weeks from the time of injury. In this cohort, allografts resulted in better outcome scores compared with autografts. Level of EvidenceLevel III Retrospective Cohort Study

Favorable Outcomes Following Elbow Ulnar Collateral Ligament Reconstruction and Repair, Though Repair Associated with Increased Risk of Revision Surgery

To assess the risk of revision surgery following repair versus reconstruction of the medial ulnar collateral ligament (UCL) of the elbow in a national sample of patients in the United States. This was a retrospective cohort study of young patients (≤35 years old) who underwent primary UCL reconstruction or repair for an isolated medial UCL injury of the elbow from October 2015 through October 2022 in a large national database (PearlDiver). Patient demographic data, comorbidities, surgical details, and concomitant ulnar nerve procedures were collected. Time-to-event analyses were used to assess the risk of revision UCL surgery between groups. Two-year complication rates, including ulnar neuropathy, were also assessed. In total, 1,820 patients (69.9% reconstruction, 30.1% repair) with an average follow-up of 2.9 years met inclusion criteria. The estimated 2-year revision-free survival (95% confidence interval [CI]) was 99.5% (99.1%-99.9%) for UCL reconstruction compared to 97.9% (96.4%-99.3%) for UCL repair (unadjusted Log-rank p=0.032). UCL repair remained associated with an increased risk of revision UCL surgery after adjusting for confounding variables (hazard ratio 2.94, 95% CI 1.07-8.09, p=0.037). Complication rates were similar between reconstruction and repair, including the incidence of ulnar neuropathy (13.8% vs. 14.5%, p=0.78). In this study, we found that UCL repair was associated with a significantly higher risk of revision UCL surgery than UCL reconstruction in a national sample. Importantly, however, overall failure rates were low and complication rates were similar between procedures. These findings support the overall favorable outcomes of UCL repair, while suggesting it may not necessarily be the optimal treatment for all patients. 3 - retrospective cohort study.

MCL augmentation using a peroneus longus split tendon autograft satisfactorily restores knee stability with no impairment in foot function and with a low failure rate for concurrent ACL reconstruction.

Addressing grade 2 and 3 medial-sided instabilities during anterior cruciate ligament (ACL) reconstruction is crucial to reduce the risk of ACL graft failure. This study introduced a minimally invasive, medial collateral ligament (MCL) augmentation technique using a peroneus longus split tendon autograft, which was fixed to the femoral deep MCL insertion and tibial superficial MCL insertion. This prospective, longitudinal, single-centre case series included patients who underwent MCL augmentation concurrent with primary or revision ACL reconstruction due to anteromedial instability. Preoperatively and at 1-year follow-up, clinical examinations, such as rolimeter test of anterior tibial translation and medial instability, knee (International Knee Documentation Committee subjective knee form [IKDC], Lsyholm, Knee Injury and Osteoarthritis Outcome Score [KOOS]) and foot function scores (American Orthopaedic Foot and Ankle Society score [AOFAS]) and complications, were analyzed. Thirty-one patients with a mean follow-up of 13.5 ± 2.6 months and a mean age of 27.8 ± 9.6 years were included. The side-to-side difference for anterior tibial translation significantly improved from preoperative to 1-year follow-up with an ACL reconstruction failure rate of 6.5%. No patient retained a grade 2 or 3 medial instability on valgus stress testing with 30° flexion. Significant improvements from preoperative to 1-year postoperative follow-up were observed in knee function scores: IKDC (48.9 ± 26.9- 71.3 ± 11.5, p < 0.001) and Lysholm (59.9 ± 28.5-80.5 ± 11.2, p = 0.002) as well as KOOS pain, ADL, sport and QoL, each reaching the respective minimal clinically important difference values. The foot function score AOFAS showed no significant impairment (100 ± 0-99.3 ± 2.5, p = 0.250). Complications included cyclops lesions of ACL reconstruction in three patients. At 1-year follow-up, MCL augmentation using a peroneus longus split tendon autograft for patients simultaneously undergoing ACL reconstruction satisfactorily restores knee stability, has a low ACL reconstruction failure rate and does not significantly impair foot function. Level IV therapeutic study; case series.

Using Video-Fluoroscopy and Multibody Modelling to Unveil the Influence of a Gradually Reducing Femoral Radius on Ligament Elongation Patterns Following Posterior Cruciate-Retaining Total Knee Arthroplasty

Stability in total knee arthroplasties (TKAs) is mainly provided by soft tissue structures and the implant geometry. Paradoxical anterior translation could be decreased with a gradually reducing femoral radius compared to a dual-radii design. However, the influence of the sagittal curvature of the femoral condyles on knee ligaments remains unclear. This study quantified the length change patterns of the medial and lateral collateral ligaments (MCL and LCL) and posterior cruciate ligament (PCL) in 15 subjects with a gradually reducing radius and 15 subjects with a dual-radii TKA. Kinematics obtained from video-fluoroscopy were used to drive personalised multibody knee models. The ligament lengths were analysed throughout complete cycles of level gait, stair descent, and sit-to-stand-to-sit activity. Regardless of the implant design, our results indicated flexion-dependent elongation patterns in all ligament bundles. Importantly, however, subjects with the dual-radii implant design exhibited higher ligament strains during the mid-flexion phase compared to those with gradually reducing designs. Our findings, therefore, emphasise the importance of the impact of subtle changes in implant geometry on the loading patterns of the knee soft tissues, which need to be acknowledged by implant manufacturers and orthopaedic surgeons.

Biomechanical comparison of four isometric prosthetic ligament repair techniques for tarsal medial collateral ligament injury.

To compare the stability, ultimate strength, and isometry of 4 prosthetic ligament repairs for canine tarsal medial collateral ligament injury. 24 cadaveric canine distal hind limbs with induced medial tarsal instability were randomly divided into 4 groups. Simulated medial shearing injury of the collateral and medial malleolus were repaired using 1 of 4 isometric suture techniques: bone tunnels with nylon suture (TN), ultrahigh-molecular-weight polyethylene (UHMWPE) suture (TU), tibial bone anchor with nylon suture (AN), or talar bone anchor with UHMWPE suture (AU). Each repair was evaluated for medial stability before and after cyclic range of motion. 3 of 4 repair configurations allowed string potentiometer isometry data collection during cyclic range of motion. Each construct was subsequently tested to failure; the strength and failure mode were recorded. All repair groups showed statistically increased laxity compared to intact ligament. There was no difference in joint laxity between repair techniques. Cyclic range-of-motion testing did not increase joint laxity at any tested joint angle. Strength to failure was no different between repair groups. Isometry was achieved in the TU and TN groups. All 4 techniques improved medial stability compared to that medial collateral ligament injury; however, no technique returned stability to the tarsal of the intact ligament. All 4 techniques maintained stability after range-of-motion testing. Isometric placement of the prosthetic suture was achievable. The constructs did not provide sufficient resistance to physiologic valgus stress. Isometric placement of a prosthetic ligament is possible; secondary stabilization appears necessary to support the repair postoperatively.

Ossification of the medial collateral and lateral collateral ligament of knee in a 19-year-old female

This case report discusses an uncommon presentation of Pellegrini-Stieda syndrome (PSS), characterized by ossification of the medial collateral ligament (MCL) of the knee, extending to the lateral collateral ligament (LCL) in a 19-year-old female patient. Typically, PSS involves post-traumatic calcification of the MCL, but this case uniquely presents ossification in both the MCL and LCL, a phenomenon not widely documented. The patient, a young laborer from a lower socio-economic background, developed knee pain and restricted movement following a fall. Diagnostic imaging revealed the unusual ossifications, leading to a diagnosis of PSS. The patient was treated with steroid injections under fluoroscopic guidance, resulting in significant improvement in knee mobility. This report highlights the importance of recognizing atypical presentations of PSS for accurate diagnosis and treatment, emphasizing the need for further research into the underlying mechanisms and optimal management strategies for such cases.

Effect of Graft Choice for ACL Reconstruction on Clinical Outcomes in Combined ACL and MCL Injuries: Comparison Between Bone-Patellar Tendon-Bone and Hamstring Autografts.

Background/Objectives: The optimal graft, particularly in combined anterior cruciate ligament (ACL) and medial collateral ligament (MCL) injuries, remains controversial. We evaluated the influence of graft choice between bone-patellar tendon-bone (BPTB) and hamstring autografts on clinical outcomes in combined ACL and MCL injuries. Methods: This retrospective analysis included patients with concurrent ACL and MCL injuries who underwent single-bundle ACL reconstruction with BPTB (group B) or hamstring (group H) grafts, between 2010 and 2019, with a ≥2-year follow-up. Patients were classified based on the MCL injury grade (I, II, or III). Clinical outcomes were assessed through knee stability evaluations using valgus stress radiographs and the KT-2000 arthrometer, patient-reported outcomes using the International Knee Documentation Committee (IKDC) subjective score and Lysholm score, and radiologic outcomes using the IKDC radiographic grade. Results: The study included 169 patients (group B, 92; group H, 77). No significant between-group differences in knee stability or functional outcomes were found after follow-up. Within the same MCL injury grade, particularly in high-grade MCL injuries, BPTB grafts resulted in significantly better medial stability (side-to-side difference in medial joint opening on valgus stress radiographs: grade II, p = 0.006; grade III, p = 0.039) and functional outcomes (IKDC subjective score: grade II, p = 0.045; grade III, p = 0.038) than hamstring grafts. In the hamstring group, higher-grade MCL injuries were associated with worse outcomes (Lysholm knee score, p = 0.009; IKDC subjective score, p = 0.015). Conclusions: Graft choice in ACL reconstruction with concomitant MCL injuries may affect clinical outcomes, particularly in high-grade MCL injuries. Although both graft types performed similarly overall, BPTB grafts provided superior medial stability and functional results in higher-grade MCL injuries. However, caution is needed when interpreting these results due to limitations such as the small sample size and the lack of randomization in graft selection.

Twenty year analysis of professional men’s rugby union knee injuries from the English premiership shows high rates and burden

ObjectivesTo determine the rates, severity and burden of knee injuries in professional male rugby union from the English Premiership.MethodsInjury and exposure data were captured over 20 seasons using a prospective...

Sonographic Verification and Clinical Significance of the Features of Surrounding Structures in Knee Osteoarthritis

Background: Osteoarthritis (OA) of the knee joint is one of the most dangerous diseases, the most significant manifestation of which is chronic pain syndrome. There is a low correlation between the radiographic stage of OA and pain progression. First of all, this is a variety of pain syndromes, among which is the pathology of periarticular structures (AS). To date, the contribution of this type to the clinical picture of OA has been sufficiently studied, primarily due to the fact that the list and frequency of these lesions have not yet been described.Aim: to describe the basis of the main periarticular structures in patients with different radiographic stages of knee OA according to ultrasound data.Materials and methods: The observational study has currently included 88 patients who had an outpatient appointment with a rheumatologist for knee osteoarthritis between 2021 and 2023. The study assessed 110 knee joints using clinical and ultrasound techniques.Results: The most common periarticular ultrasound changes, regardless of radiographic stage, were pes anserine tendinopathy (57.3 %), Baker’s cyst (45.5 %), fibrosis of the severe Hoffa body (40 %) and ligamentopathy of the medial collateral ligament (36). ,4). %). A significant correlation was found between the number of changes according to ultrasound and the radiological stage (ρ=0.45 [95 % CI: 0.28, 0.59], p &lt;0.001) as well as between the VAS and the definition of identified ultrasound changes (ρ= 0.29 [95 % CI: 0.11, p=0.002); In addition, it was shown that late stages of OA are associated with a greater content of changes (p &lt;0.001).Conclusion: Changes in periarticular structures are present in most patients with knee osteoarthritis; their number correlates with the VAS value and radiographic stage of OA. Details of these changes, their clinical significance and pathogenetic contribution to the progression of knee OA require further study.

Right knee ACL, PCL and MCL reconstruction with sports-related anxiety

Introduction: JM, a 20-year-old male professional ice hockey player, presented with a 2-week history of lack of range of motion, weakness, and pain in his right knee, after a 2-year post-medical collateral ligament repair of the right knee and 3 year-post anterior cruciate ligament, posterior cruciate ligament and medial collateral ligament reconstruction of the right knee. Case Description: In the course of history taken, it was revealed that 5 months prior to admission the patient had been informed by a psychiatrist that he had sport-related anxiety. With an unremarkable psychiatric history prior to age 18, the competitive nature of his sports career in addition to financial pressure may have contributed to his sports-related anxiety. His examination findings were consistent with a diagnosis of complete tears of the right anterior cruciate ligament and posterior cruciate ligament along with grade III medial collateral ligament injury. Discussion: The biopsychosocial model was used to explicate JM's case. JM's current injuries prompted reconstruction of the anterior cruciate, posterior cruciate, and medial collateral ligaments. Psychologically, JM's sports-related anxiety is not a rare phenomenon as recent studies have discovered an increased risk of sports-related anxiety amongst young professional athletes. Sports-related anxiety, along with competitive trait anxiety, may be factors that contribute to sports injury occurrence. Other psychological stressors can add to sports-related or competitive trait anxiety, further increasing the risk of sports injury reoccurrence. Summary: JM was admitted for a right knee open medial collateral ligament repair with internal bracing, anterior cruciate ligament reconstruction, posterior cruciate ligament reconstruction, and platelet rich plasma injection. As part of a holistic patient-centered treatment plan, a referral to psychiatry was made to address JM's sports-related anxiety with the goal of decreasing future risk of sports injury. Patient's Consent Obtained: Yes

Adjustable Loop Fixation in Multi-ligament Knee Injuries: A Technical Note.

Adjustable Loop Fixation devices (ALD) were introduced to allow tensioning and re-tensioning while increasing flexibility of graft length in the bone tunnel. ALDs have shown comparable clinical and biomechanical results when used for anterior cruciate ligament reconstructions. We routinely use ALDs in multi-ligament knee reconstructions. In double bundle posterior cruciate ligament reconstruction, using an ALD, we can achieve differential tensioning of the anterolateral and posteromedial bundles utilizing two femoral and one tibial tunnel. When performing an anatomic posterolateral corner reconstruction using our modification of the anatomical LaPrade technique, an ALD permits differential tensioning of the fibular collateral ligament and popliteus tendon/popliteofibular ligaments with a single graft. In anatomic superficial medial collateral ligament reconstructions, ALD allows for tensioning from the femoral side, subsequent cycling, followed by re-tensioning to achieve a stable reconstruction. In conclusion, ALDs provide numerous benefits when performing multi-ligament knee reconstructions. ALDs allow for appropriate tensioning and re-tensioning which is helpful in removing creep from the graft to prevent postoperative laxity. Additionally, it permits differential tensioning which helps achieve accurate tensioning of individual bundles to help restore native knee kinematics.

Multiple knee ligament tear: Magnetic Resonance imaging diagnosis

The rupture of the anterior cruciate ligament is common during physical activities; however, when associated with a multiple ligament injury, it represents an uncommon condition. The diagnosis of this injury is commonly delayed or missed. Consequently, the incidence of this injury may in fact be higher than reported. We present a case of a 27-year-old man with complete tear of the anterior cruciate ligament and of the medial collateral ligament and partial tear of the posterior cruciate, lateral collateral and patellar ligaments treated surgically.

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..

Оutcome of neglected posterior elbow dislocation with gross ligamentous instability by arthrolysis combined with circumferential reconstruction of MCL, LUCL using triceps tendon fascia

Dislocation of the elbow joint, which has not been treated for more than 3 weeks, is considered outdated. Due to the high risk of complications and the uncertainty of the effectiveness of the treatment of an old dislocation of the elbow joint, it is quite a difficult task for surgeons. There are various described techniques for repairing the lateral ligamentous complex (including the LUCL) and the medial collateral ligament. Objective. To describe the author's unique technique, which consists in using one graft to restore both lateral and medial ligaments. Methods. The personal experience of treating 14 patients with chronic dislocation of the elbow joint with deformation and multidirectional instability is presented. All patients were operated on by one surgeon using the arthrolysis method in combination with MCL, LUCL reconstruction using an ipsilateral autograft of the triceps tendinous fascia. Further observation was carried out at 3, 6 and 12 weeks, as well as at 6 and 9 months. In our case, we evaluated stability, range of motion, and the presence of pain syndrome. The results. Satisfactory results were obtained in terms of pain-free full range of motion and adequate stability of the elbow joint in all cases. All patients performed their active routine exercise with minimal limitation. Conclusions. The advantage of the technique is a unique comprehensive approach that uses one circular graft to restore both the lateral and medial ligament complexes, which ensures stability and possible early rehabilitation. This leads to an excellent functional result — a quick restoration of the full range of motion in the joint and its stability.

Medial soft tissue release is also related to the anterior stability of cruciate-retaining total knee arthroplasty: a cadaveric study.

Medial soft tissue release is occasionally performed to achieve mediolateral ligament balance in total knee arthroplasty (TKA), whose sequential effect on mediolateral and anteroposterior stability remains unclear. This study aimed to quantitatively evaluate the difference in mediolateral and anteroposterior stability according to a sequential medial soft tissue release in TKA. Cruciate-retaining TKA was performed in six cadaveric knees. Medial and lateral joint gaps, varus-valgus angle, and tibial anterior and posterior translations relative to the femur with pulling and pushing forces, respectively, were measured. All measurements were performed at full extension and 45° and 90° flexion after release of the deep medial collateral ligament (MCL) (stage 1), the posteromedial capsule (stage 2), and the superficial MCL (stage 3). Mediolateral and anteroposterior stability were compared between stages, and correlations between mediolateral and anteroposterior stability were analyzed. Medial joint gap significantly increased from stages 1 to 3 by 3.2mm, 6.8mm, and 7.2mm at extension, 45° flexion, and 90° flexion, respectively, and from stages 2 to 3 by 3.5mm at extension. Varus-valgus angle was varus at stage 2, which turned to valgus at stage 3 (-2.7° to 0.8°, -2.2° to 4.3°, and -5.5° to 2.5° at extension, 45° flexion, and 90° flexion, respectively). Anterior translation at 90° flexion significantly increased from stages 1 and 2 to stage 3 by 11.5mm and 8.2mm, respectively, which was significantly correlated with medial gap (r = 0.681) and varus-valgus angle (r = 0.495). Medial soft tissue release also increased tibial anterior translation as well as medial joint gap, and medial joint gap and tibial anterior translation were significantly correlated. Surgeons should be careful not to create too large medial joint gap and tibial anterior translation in flexion by excessive medial release up to the superficial MCL for achieving an equal mediolateral joint gap in extension.