Medial Collateral Ligament Research Articles

A lateral approach allows accurate and stable total elbow replacement in dogs.

Evaluate whether total elbow replacement (TER) through a lateral approach is accurate and stable. 12 skeletally mature large-breed dog cadavers were used. Limb alignment, elbow joint motion, and collateral ligament laxity were evaluated preoperatively. The order of surgery (left or right) and the approach (lateral or medial) were randomly selected for TER in each dog. The other approach was used in the contralateral elbow. Intraoperative technical difficulties, duration of surgery, and anatomic complications were recorded. Limb alignment, elbow joint motion, collateral ligament laxity, and prosthetic component alignment were evaluated after surgery. Data were collected from June 11 to 15, 2023. The duration of surgery using a lateral or medial approach did not differ (P = .499). Anatomic complications were not observed. The lateral approach resulted in 8° more elbow extension (P = .003), 1.58° less lateral collateral ligament constraint (P = .033), 2.80° less medial collateral ligament constraint (P = .002), 4.38° less frontal plane constraint (P = .004), 8° greater humeral component inclination (P = .033), and 5.6° greater radioulnar component varus (P = .001) than the medial approach. Varus of the radius, mechanical axis deviation, limb supination, elbow flexion, mediolateral humeral component and craniocaudal radioulnar component orientation did not differ among joints operated using a lateral or medial approach. In normal cadaveric elbows, a lateral approach for TER appears feasible, producing equivalent limb alignment, joint laxity, and joint motion to normal elbows and to TER placed using a medial approach. In dogs, TER can be performed using a lateral surgical approach.

METTL14-mediated lncRNA-FAS-AS1 promotes osteoarthritis progression by up-regulating ADAM8.

Osteoarthritis (OA) is a prevalent degenerative disease. We explored the role and regulatory mechanisms of lncRNA-FAS-AS1 in OA progression. We exposed human immortalized chondrocytes to IL-1β for 24 h to induce an OA cell model. The target molecule levels were assessed using western blot and quantitative real-time PCR (RT-qPCR). Cell viability and apoptosis were measured using CCK-8 and flow cytometry. The m6A modification of FAS-AS1 was determined using MeRIP. We examined the binding relationships between FAS-AS1, Fragile X mental retardation 1 (FMR1), and A disintegrin and metalloproteinase 8 (ADAM8) using RIP and RNA pull-down. The OA animal model was established by separating the medial collateral ligament and medial meniscus. Safranin-O staining and Mankin's scale were employed to evaluate pathological changes within the cartilage. FAS-AS1, METTL14, and ADAM8 were upregulated, and the JAK/STAT3 signaling pathway was activated in OA mice and IL-1β-induced chondrocytes. FAS-AS1 knockdown inhibited extracellular matrix degradation in IL-1β-induced chondrocytes; however, ADAM8 overexpression reversed this effect. FAS-AS1 maintained the stability of ADAM8 mRNA by recruiting FMR1. METTL14 knockdown repressed FAS-AS1 expression in an m6A-dependent manner. FAS-AS1 overexpression reversed the inhibitory effects of METTL14 knockdown on JAK/STAT3 signaling and cartilage damage in the OA model both invitro and invivo. METTL14-mediated FAS-AS1 promotes OA progression through the FMR1/ADAM8/JAK/STAT3 axis.

Efficacy and adverse reactions of arthroscopic medial collateral ligament release for medial meniscus injury: A meta-analysis

The posterior root tear of the medial meniscus has received increasing attention from scholars in recent years, with its incidence rate accounting for 10.1%–27.8% of all meniscal tears. A comprehensive search of eight databases was conducted to identify studies on the efficacy and negative consequences of arthroscopic medial collateral ligament release for medial meniscus damage. Data analysis was performed using RevMan 5.3 software, following a thorough assessment of the literature quality. A total of seven studies were included in this meta-analysis. Based on the data from these studies, there was no statistically significant difference between the test group and the control group in terms of Lysholm scores [standardized mean difference (SMD): 3.23; 95% confidence interval (CI): −1.61, 8.06; P = 0.191], IKDC scores (SMD: 0.42; 95% CI: −3.54, 4.37; P = 0.837), VAS scores (SMD: −0.48; 95% CI: −1.36, 0.40; P = 0.283), and operation time (SMD: −24.87; 95% CI: −41.68, −8.05; P < 0.01). According to Lysholm scores, IKDC scores, VAS scores, operation time, and adverse reactions, the findings of this research imply that arthroscopic medial collateral ligament release may be favorable to people who have medial meniscus injury. Nevertheless, current outcomes require confirmation by additional studies of excellent quality.

Reconstruction of the medial collateral ligament complex with aflat semitendinosus auto- or allograft

Replacement of superficial medial collateral ligament (sMCL) and posterior oblique ligament (POL) with an allograft. Chronic 3° isolated medial instability and combined anteromedial or posteromedial instability. Infection, open growth plates, restricted range of motion (less than E/F 0-0-90°). Longitudinal incision from medial epicondyle to superficial pes anserinus and exposure of the medial collateral ligament complex. Thawing of the allogeneic semitendinosus tendon graft at room temperature, reinforcement of the tendon ends with sutures and preparation of atwo-stranded graft. Placement of guidewires in the sMCL and POL insertions and control with image intensifier. Tunnel drilling. Pulling the graft loop into the femoral bone tunnel and fixation with aflip button. Pulling the two graft ends into the tibial tunnels. Tibial fixation by knotting the suture ends in a20° flexion on the lateral cortex. Suture the tendon bundles to the remaining remnants of the medial collateral ligament complex to adopt the flat structure of the natural medial collateral ligament complex. Six weeks partial weight-bearing, immediately postoperatively splint in the extended position, after 2weeks movable knee brace for another 4-6weeks. Mobility: 4weeks 0-0-60, 5th and 6th weeks 0-0-90. From 2015-2021, this surgical procedure was performed in 19patients (5women, 14men, age34years). Mean Lysholm score at follow-up after at least 2years was 89 (76-99) points. In 6patients, there was restricted range of motion 3months postoperatively, which resulted in further therapy (3 ×systemic cortisone therapy, 3 ×arthroscopically supported manipulations under anesthesia).

Anterior-Posterior Laxity in Midflexion After Posterior-Stabilized TKA Is Sensitive to MCL Tension in Passive Flexion: An in Vitro Biomechanical Study.

Knee instability in midflexion may contribute to patient dissatisfaction following total knee arthroplasty (TKA). Midflexion instability involves abnormal motions and tissue loading in multiple planes. Therefore, we quantified and compared the tensions carried by the medial and lateral collateral ligaments (MCL and LCL) following posterior-stabilized (PS) TKA through knee flexion, and then compared these tensions with those carried by the native knee. Finally, we examined the relationships between collateral ligament tensions and anterior tibial translation (ATT). Eight cadaveric knees (from 5 male and 3 female donors with a mean age of 62.6 years and standard deviation of 10.9 years) underwent PS TKA. Each specimen was mounted to a robotic manipulator and flexed to 90°. ATT was quantified by applying 30 N of anterior force to the tibia. Tensions carried by the collateral ligaments were determined via serial sectioning. Robotic testing was also conducted on a cohort of 15 healthy native cadaveric knees (from 9 male and 6 female donors with a mean age of 36 years and standard deviation of 11 years). Relationships between collateral ligament tensions during passive flexion and ATT were assessed via linear and nonlinear regressions. MCL tensions were greater following PS TKA than in the native knee at 15° and 30° of passive flexion, by a median of ≥27 N (p = 0.002), while the LCL tensions did not differ. Median tensions following PS TKA were greater in the MCL than in the LCL at 15°, 30°, and 90° of flexion, by ≥4 N (p ≤ 0.02). Median tensions in the MCL of the native knee were small (≤11 N) and did not exceed those in the LCL (p ≥ 0.25). A logarithmic relationship was identified between MCL tension and ATT following TKA. MCL tensions were greater following PS TKA with this typical nonconforming PS implant than in the native knee. Anterior laxity at 30° of flexion was highly sensitive to MCL tension during passive flexion following PS TKA but not in the native knee. Surgeons face competing objectives when performing PS TKA: they can either impart supraphysiological MCL tension to reduce anterior-posterior laxity or maintain native MCL tensions that lead to heightened anterior-posterior laxity, as shown in this study.

PERBEDAAN KECEPATAN BERJALAN PADA PENGGUNA TRANSTIBIAL PROSTHESIS TIPE SACH FOOT DAN SINGLE AXIS FOOT

Background: Amputation can be defined as the act of separating part of the body, part or all of an extremity. Currently, lower limb amputations account for 85-90% of all amputations and transtibial amputation is the most frequently performed type of amputation surgery. One of the problems with transtibial amputation is hyperextension and weakness of the ligaments in the knee. Knee hyperextension is a condition that occurs when the knee joint is extended (straightening the knee) excessively, thus putting pressure on the structure of the knee and the back of the knee joint. Ligament weakness in the knee is weakness in the anterior cruciate ligament, posterior cruciate ligament, medial collateral ligament and lateral collateral ligament. Choosing the right prosthesis components can overcome this. One component that plays an important role is the foot component. Methods: This type of research is observational analytic with a cross-sectional design. The research subjects were 17 transtibial prosthesis users. Data analysis in this study used Spearman Rank Test. Results: Based on the Spearman Rank results, the significance result was 0.653 for the type of foot with hyperextension, while for the type of foot with ligament weakness, the significance result was 0.434. Both variables had variable values > 0.05, meaning there was no correlation between foot type and hyperextension and ligament weakness in transtibial prosthesis users. Conclusion: There is no correlation type of foot to hyperextension and ligament weakness. In future research, it is hoped that research can be carried out with a larger number of samples and a more varied type of foot.

Clarifying the relation between the marrow contusion pattern around the knee and the types of concomitant intra-articular soft tissue injuries

BackgroundAcute knee injuries represent a prevalent cause of morbidity among athletes and, if overlooked, could potentially lead to the development of chronic functional limitations. This study aimed to identify marrow contusion patterns around the knee and find the relation between each pattern and the intra- and extra-articular soft tissue injuries. This was a retrospective cross-sectional study carried out on 109 patients who presented to the hospital where the study was held with recent knee joint injury, for which magnetic resonance imaging was requested from January 2017 to January 2019.ResultsThe entire patient population under investigation had a mean age of 30.2 ± 9.7 years. Regarding gender distribution, the study comprised 90 males (82.6%) and 19 females (17.4%). Regarding bone marrow contusion patterns in all studied patients, it was pivot shift in 58 patients (53.2%), clip injury in 11 patients (10.1%), dashboard injury in 7 patients (6.4%), hyperextension injury in 3 patients (2.8%), lateral patellar dislocation in 15 patients (13.8%), and others in 15 patients (13.8%). In the pivot shift pattern group, anterior cruciate ligament (ACL), medial meniscus, and medial collateral ligament (MCL) injuries were most commonly seen in 94.8, 50, and 44.8% of patients, respectively. Among the clip pattern group, MCL, ACL, and medial meniscus injuries were most common in 90.9, 36.4, and 36.4%, respectively. Regarding the dashboard injury group, posterior cruciate ligament (PCL), ACL, and medial and lateral menisci were the most common injury structures (100, 57.1, 42.9, and 42.9%, respectively). Despite the hyperextension pattern being found in a small number of patients, it shows 100% medial meniscal and 66.7% PCL injuries. Within the group of lateral patellar dislocation patterns, 100% of cases exhibited injuries to the medial patellofemoral ligament.ConclusionsPrecise localization of the marrow contusion around the knee and defining its pattern help to anticipate the most probable associated soft tissue injuries and, thus, can increase our sensitivity in their detection. This can have a better impact on patients' management outcomes.

Two-Year Functional Outcomes of Nonsurgical Treatment in Concomitant Anterior Cruciate Ligament and Medial Collateral Ligament Injuries: A Case-Control Study.

The anterior cruciate ligament (ACL) is a common knee injury in high-intensity sports, which can cause early career loss in young athletes. Concomitant damage to other knee stabilizers may occur, such as the medial collateral ligament (MCL). Recent studies have shown that knee stability can increase without surgical intervention in patients with ACL and MCL injuries. Regarding the importance of functional tests in return to exercise prediction, this study aims to measure nonsurgical approach's long-term outcome for concomitant ACL and MCL injuries with a focus on functional tests. This is a case-control study with a 2-year follow-up. The case group consisted of patients who had provided written consent and completed their 2-year follow-up, and the control group was made up of healthy people who did not have any knee medical conditions and were matched by age, gender, and activity level. Physical examinations, Tegner and International Knee Documentation Committee questionnaires, and knee magnetic resonance imaging were conducted, and functional performance tests were performed after a 10-minute warm-up. Lody's index (the ratio of injured-to-uninjured knee results) was calculated. The data were analyzed using independent t-test, one-way analysis of variance, chi-squared test, and Fisher's exact test. The study involved 11 patients in each concomitant ACL and MCL injury cases and healthy control groups with a mean age of 32.4 and 28 years, respectively. None of the patients reported knee instability symptoms in the 2-year follow-up. More than half of the patients continued their sports field without reinjury, with no significant difference in activity levels between case and control groups. The 6-meter hop test and single-leg hop test showed no significant difference between case and control groups (p-value: 0.326, 0.859), and no significant difference was observed in the three Carioca, cocontraction, and Shuttle tests in the 2-year follow-up. Functional tests in ACL and MCL injuries revealed normal outcomes, implying a nonsurgical approach for patients with proximal ACL tears, better knee stability, and no significant differences between the injured and control groups.

Prevalence of Concomitant Injuries by Sport in Pediatric Patients With ACL Rupture.

Although the risk of concomitant injury with anterior cruciate ligament (ACL) tears as a function of specific sports participation has been studied in adults, the topic has not been examined in pediatric and adolescent patients. The purpose of the study was to determine if certain sports were associated with a higher risk of concomitant injuries in the setting of an ACL tear. It was hypothesized that the risk of concomitant injuries with ACL tears will differ by type of sport participation in the pediatric population. Cross-sectional study; Level of evidence, 3. Patients ≤18 years old from 2 tertiary children's hospitals who had undergone primary ACL reconstruction between 2006 and 2018 were included. Sport at the time of injury, demographic factors, and injury pattern (medial meniscal [MM] tears, lateral meniscal [LM] tears, posterior cruciate ligament [PCL] tears, medial collateral ligament [MCL] tears, lateral collateral ligament [LCL] tears, and any concomitant injury) were identified. A total of 855 patients with a mean age of 15.5 ± 1.7 years (range, 7-22 years) met the inclusion criteria. Of the included patients, 353 (41.3%) had an isolated ACL tear. A concomitant MM tear was identified in 27.6% of patients, LM tear in 42.9%, PCL injury in 0.4%, MCL injury in 3.0%, and LCL injury in 0.5%. There was no difference in the likelihood of concomitant MM injuries by sex (29.3% for male patients vs 26% for female patients; P = .31) or by sex within basketball (29.3% for male patients vs 25.6% for female patients; P = .96) or soccer (32.3% vs 26.3%; P = .06). Boys had higher proportions of LM injuries overall (51.7% for male patients vs 34.6% for female patients; P < .001) but not within the basketball subgroup (50.5% vs 40.0%; P = .86) or the soccer subgroup (59.7% vs 40.0%; P = .19). No statistically significant associations were found between patient age and specific ACL concomitant injury patterns. When stratifying by body mass index, it was found overweight and obese individuals constituted a greater proportion of LM (49.6% vs 39.1%; P = .01) but not MM (29.4% vs 25.5%; P = .28) injuries when compared to normal-weight patients. Using basketball as the comparison group, soccer and football injuries were 18% more likely to result in any concomitant injury, including concomitant MM, LM, PCL, MCL, and LCL injuries. In the pediatric population, soccer and football players were more likely to present with a concomitant injury in addition to ACL injury relative to basketball players. This study aids in understanding sport-associated ACL injury patterns and can help physicians with patient counseling and injury prevention.

Career Length After Surgically Treated ACL Plus Collateral Ligament Injury in Elite Athletes

Background: Limited data are available regarding career length and competition level after combined anterior cruciate ligament (ACL) and medial- or lateral-sided surgeries in elite athletes. Purpose: To evaluate career length after surgical treatment of combined ACL plus medial collateral ligament (MCL) and ACL plus posterolateral corner (PLC) injuries in elite athletes and, in a subgroup analysis of male professional soccer players, to compare career length and competition level after combined ACL+MCL or ACL+PLC surgeries with a cohort who underwent isolated ACL reconstruction (ACLR). Study Design: Cohort study; Level of evidence, 3. Methods: A consecutive cohort of elite athletes undergoing combined ACL+MCL and ACL+PLC surgery was analyzed between February 2001 and October 2019. A subgroup of male elite soccer players from this population was compared with a previously identified cohort having had isolated primary ACLR without other ligament surgery. A minimum 2-year follow-up was required. Outcome measures were career length and competition level. Results: A total of 98 elite athletes met the inclusion criteria, comprising 50 ACL+PLC and 48 ACL+MCL surgeries. The mean career length after surgical treatment of combined ACL+MCL and ACL+PLC injuries was 4.5 years. Return-to-play (RTP) time was significantly longer for ACL+PLC injuries (12.8 months; P = .019) than for ACL+MCL injuries (10.9 months). In the subgroup analysis of soccer players, a significantly lower number of players with combined ACL+PLC surgery were able to RTP (88%; P = .003) compared with 100% for ACL+MCL surgery and 97% for isolated ACLR, as well as requiring an almost 3 months longer RTP timeline (12.9 months; P = .002) when compared with the isolated ACL (10.2 months) and combined ACL+MCL (10.0 months) groups. However, career length and competition level were not significantly different between groups. Conclusion: Among elite athletes, the mean career length after surgical treatment of combined ACL+MCL and ACL+PLC injuries was 4.5 years. Professional soccer players with combined ACL+PLC surgery returned at a lower rate and required a longer RTP time when compared with the players with isolated ACL or combined ACL+MCL injuries. However, those who did RTP had the same career longevity and competition level.

A Study Evaluating the Functional Outcomes of Mason Type III and IV Radial Head Fractures Treated With a Radial Head Prosthesis.

Objective This research aimed to assess the functional result of type III and IV radial head fractures that were treated using a radial head prosthesis. Methods A retrospective investigation was conducted on 70 patients with type III and IV radial head and neck fractures, as classified by Mason. The patients were hospitalized and received treatment at the Orthopaedics Department, where they had radial head prosthesis surgery for three years. Results Among the total of 70 cases, 42 (60%) cases were below the age of 40, while 28 (47%) cases were over 40 years. The average age was 36.4 years. The maximum age recorded was 54 years, while the lowest age recorded was 30 years. The female population outnumbered the male population. The majority of instances (42, 60%) were attributed to falls, while the remaining cases were caused by road traffic accidents (RTAs). Out of the total 70 instances, 52 cases (74.28%) exhibited right-side dominance, whereas 18 cases (25.72%) exhibited left-side dominance. Within our case study group, 56 (80%) cases fell under modified Mason's classification type Ill, totaling 56 instances. The remaining 20% of the cases, amounting to 11 cases, were classified as modified Mason's classification type IV. Among the 70 patients, 55 cases (78.58%) did not have any ligamentous damage, whereas seven (10%) cases had lateral ulnar collateral ligament (LUCL) injury and eight (11%) cases had medial collateral ligament (MCL)injury. The P value for flexion, extension, pronation, and supination was shown to be very significant. Out of the total, 47 (67%) instances had an MEPI score (Mayo Elbow Performance Index) of more than 90, indicating exceptional performance. In addition, 16 cases (22.85%) had an MEPI score ranging from 75 to 89, which is considered a good result. Lastly, seven cases (10%) had an MEPI score ranging from 60 to 74, indicating a fair result. Conclusion The use of a radial head prosthesis is considered a viable option for managing severe and irreparable fractures of the radial head. Effective outcomes hinge on meticulous preoperative planning, skilled intraoperative techniques, and intensive postoperative rehabilitation. These elements collectively contribute to achieving consistent and favorable results in patients undergoing this surgical intervention.

Examining the changes in strength and mechanical property of dynamic stabilizers of the medial elbow joint through repetitive pitching

The flexor-pronator muscles (FPM) and their common tendon (CT) are essential in protecting the medial ulnar collateral ligament against elbow valgus stress during pitching. This study aimed to investigate the effect of repetitive pitching on FPM strength and CT stiffness. Fifteen healthy males (mean age: 21.8 ± 1.3-years-old) with over 5 years of baseball experience performed a series of 100 full-effort fastball pitches. We measured grip and isolated digital flexion strength of the second, third, and fourth digits before and after the pitching task. The decline in muscle strength was determined using the rate of change in muscle strength after pitching relative to that before. CT stiffness was measured using a hand-held myotonometer device at rest and during grip motion at 50% maximum voluntary contraction. The increase in CT stiffness during grip motion relative to rest was calculated as the augmentation rate of CT stiffness. Statistical analyses were performed to compare the changes in grip strength, digital flexion strength, and CT stiffness due to pitching. Additionally, the reduction rate of muscle strength was compared among various strength variables. Correlation coefficients were used to evaluate the relationships between the augmentation rate of CT stiffness after pitching and the reduction rate in any muscle strength. Grip and isolated digital flexion strengths decreased significantly after pitching (P < 0.01). The decline in muscle strength was significantly higher for all isolated digital strengths than that for grip strength (P < 0.05). CT stiffness was augmented with grip motion compared to that at rest pre- and post-pitching (P < 0.001). However, no change in CT stiffness due to pitching was observed, regardless of the grip motion (P > 0.05). Additionally, a lower augmentation rate of CT stiffness after pitching was moderately associated with the greater reduction rate of the second digital flexion strength (r = 0.607, P = 0.016) without other relationships. This study found reduced grip and digital flexion strength after pitching; with no change in CT stiffness. However, given the consequences of correlation analyses, individuals with a more prominent reduction in second digital flexion strength due to pitching were impaired in CT stiffness augmentation after pitching. Digital flexion strength represents the strength of the flexor digitorum superficial; therefore, this study suggests that forearm FPM, particularly the second digit of the flexor digitorum superficial, is an important factor for enhancing CT stiffness.

Ulnar Collateral Ligament Reconstruction Utilizing a 3-Strand Palmaris Tendon Autograft With a Hybrid Linear Construct

The integrity of the medial ulnar collateral ligament (UCL) of the elbow is vital for the throwing athlete. Although newer techniques exist, reconstruction remains the gold standard for full-thickness UCL tears. An increase in throwing velocity, inadequate recovery, and early sports specialization have contributed to increased rates of UCL injury. As increasing numbers of athletes undergo UCL reconstruction, we continue to search for the optimal technique to return athletes to the same level of competition. We present a UCL reconstruction utilizing a 3-stranded palmaris longus tendon autograft with an inlay linear construct.

Medial Ligament Complex Reconstruction With Allograft Using Less Invasive Onlay Fixation and Suture Tape Augmentation

Injury to the medial complex of the knee may result in persisting valgus and rotatory instability. In combination with concomitant meniscotibial ligament disruption, maldistributed contact forces are placed on the medial compartment, which may result in the progression of osteoarthritis. When facing chronic valgus and/or posteromedial instability, definitive treatment with medial ligament complex reconstruction in combination with additional repair of the meniscotibial ligament when necessary should be done to anatomically restore proper knee biomechanics and kinematics. This technique describes reconstruction of both the superficial medial collateral ligament (sMCL) and posterior oblique ligament with a single allograft, with additional suture tape augmentation used to reinforce the sMCL. Additionally, less invasive onlay fixation is used via a knotless loop mechanism to secure the posterior oblique ligament to its tibial insertion and the sMCL at 2 points along its distal tibial insertion.

Location of medial collateral ligament tears: introduction to a magnetic resonance imaging-based classification.

Despite established tear grade classifications, there is currently no radiological classification for sMCL tear locations. This study aims to establish a magnetic resonance imaging (MRI) tear location classification system for sMCL tears, to enhance understanding and guide treatment decisions by categorizing tear types. A retrospective search in a single institution's MRI database identified patients with acute, Grade III sMCL tears (< 30days between injury and MRI) from January to December 2022. Non-acute and partial tears were excluded, and three observers assessed tear types based on the proposed sMCL MRI tear location system: type I (proximal 25%), Ib (proximal femoral bony avulsion), II (midsubstance, 25-75%), III (distal 25%), IIIb (distal tibial bony avulsion), IIIs (Stener-like lesion). The interclass correlation coefficient (ICC) was used to assess interrater and intrarater reliability for continuous data; Fleiss and Cohen's kappa assessed interrater and intrarater reliability for categorical data. MRI scans of thirty patients with diagnosed sMCL injuries (53% female, mean age 37 ± 13years, range 16-68years) were included based on inclusion/exclusion criteria. Interrater reliability was excellent (ICC: 0.968, 95% CI, 0.933-0.985), and intrarater reliability was excellent (ICC: 0.938, 95% CI: 0.874-0.970 & 0.900, 95% CI, 0.789-0.952). Type I injuries were most common (60%), followed by type III (33.3%), type II (3.3%), type Ib (3.3%), type IIIb (0.0%), and type IIIs (0.0%). The presented MRI-based sMCL tear location classification provides a reproducible system for grading high-grade sMCL injuries. We propose that this framework will significantly unify tear location understanding and support more informed treatment decisions.

Decision-making in unicompartmental knee arthroplasty using radiological parameters in South Asian populations

Background: Many patients who visit orthopedic surgeons mainly complained of knee pain, which is often diagnosed as osteoarthritis affecting the medial compartment, whereas the lateral compartment and patello-femoral joint remain relatively unaffected. AIM: This study aimed to establish criteria for patient selection and validate an evidence-based approach for selecting candidates for unicompartmental knee arthroplasty (UKA). Key considerations in patient selection for UKA include identifying the presence of bone-on-bone osteoarthritis in the medial compartment, ensuring a functionally normal anterior cruciate ligament, maintaining full-thickness cartilage in the lateral compartment, verifying a functionally normal medial collateral ligament, and confirming the absence of severe damage lateral to the patello-femoral joint. MATERIALS AND METHODS: From a consecutive cohort of 390 patients with medial knee pain, preoperative radiographs of bilateral knee including anteroposterior/lateral/Rosenberg/20° valgus stress views were collected, and results were tabulated. Patients were categorized into appropriate groups. The suitability for UKA was determined based on the Oxford radiological decision aid, history, examination, and radiographic assessment including stress radiographs. RESULTS: The Oxford radiological decision aid demonstrated 92% sensitivity and 88% specificity. According to the radiographic assessment, 49% of the knees were considered suitable for Oxford UKA (OUKA), whereas 51% were deemed unsuitable. Among the 51 knees identified as unsuitable for OUKA, 40% did not meet one radiographic criterion, 38% did not meet two criteria, 22% did not meet three criteria, and 1% did not meet four criteria. CONCLUSION: The Oxford radiographic decision aid safely and reliably identifies the appropriate patients for meniscal-bearing UKA and achieves good results in this population. The widespread use of this radiological decision aid should improve the results of UKA.

Ligament augmentation and reconstruction system (LARS) synthetic grafts are safe and effective for medial collateral ligament and posterolateral corner reconstructions in elite athletes.

This study documents the efficacy and safety of using a Ligament Augmentation and Reconstruction System (LARS) ligament graft to augment extra-articular knee ligament reconstructions in elite athletes by reporting return-to-play(RTP) rates and levels, career longevityand complications. A consecutive series of all extra-articular knee ligament reconstructions augmented by LARS ligaments in elite athletes undertaken by three specialist sports knee surgeons between 2013 and 2020 were reviewed. Seventy-six elite athletes, aged over 16 years old, and more than 2 years postsurgery were included. RTPwas defined as competing at professional levelor national/international level in amateur sport. There were 64 medial collateral ligament (MCL) and 12 posterolateral corner (PLC) reconstructions. Fifty-two (68.4%) underwent concomitant autograft cruciate ligament(s) reconstruction. The mean age was 25.1 years (SD ± 4.5). Most were football (35, 46.1%) or rugby players (35, 46.1%). Sixty-seven athletes (88.2%) RTP with 65 (97.0%) of these playing at the same or higher Tegner level. Fifty-six (83.6%) of the athletes that RTP were still playing at 2 years postsurgery. Twenty (57.1%) of those who had RTP and were more than 5 years postsurgery were still playing at 5 years. Six (7.9%) players required further surgery relating to the LARS/metalwork. One case had soft tissue inflammation adjacent to the proximal end of the synthetic graft, but it is unknown if this was mechanical irritation or a biological reaction. One MCL reruptured 4 years after RTP. Utilising LARS to augment extra-articular knee ligament reconstructions allows 88.2% of athletes with a variety of knee ligament injuries to return to elite sport. The low morbidity rates coupled with 57% of athletes still playing 5 years postsurgery demonstrates that the LARS is safe and effective in these cases. Although there are reports of LARS ligaments being used in MCL and PLC reconstructions, there is very little evidence investigating if they are safe and effective. This study demonstrates that LARS synthetic grafts can be safely used for MCL and PLC reconstructions in elite athletes and they permit a high RTP with a low risk of complications. Level IV.

Effect of changes in motor skill induced by educational video program to decrease lower-limb joint load during cutting maneuvers: based on musculoskeletal modeling

BackgroundThis study investigated the effects of changes in motor skills from an educational video program on the kinematic and kinetic variables of the lower extremity joints and knee ligament load.MethodsTwenty male participants (age: 22.2 ± 2.60 y; height: 1.70 ± 6.2 m; weight: 65.4 ± 7.01 kg; BMI: 23.32 ± 2.49 \\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$kg/{m}^{2}$$\\end{document}) were instructed to run at 4.5 ± 0.2 m/s from a 5 m distance posterior to the force plate, land their foot on the force plate, and perform the cutting maneuver on the left. The educational video program for cutting maneuvers consisted of preparatory posture, foot landing orientation, gaze and trunk directions, soft landing, and eversion angle. The measured variables were the angle, angular velocity of lower extremity joints, ground reaction force (GRF), moment, and anterior cruciate ligament (ACL) and medial collateral ligament (MCL) forces through musculoskeletal modeling.ResultsAfter the video feedback, the hip joint angles increased in flexion, abduction, and external rotation (p < 0.05), and the angular velocity increased in extension (p < 0.05). The ankle joint angles increased in dorsiflexion (p < 0.05), and the angular velocity decreased in dorsiflexion (p < 0.05) but increased in abduction (p < 0.05). The GRF increased in the anterior-posterior and medial-lateral directions and decreased vertically (p < 0.05). The hip joint moments decreased in extension and external rotation (p < 0.05) but increased in adduction (p < 0.05). The knee joint moments were decreased in extension, adduction, and external rotation (p < 0.05). The abduction moment of the ankle joint decreased (p < 0.001). There were differences in the support zone corresponding to 64‒87% of the hip frontal moment (p < 0.001) and 32‒100% of the hip horizontal moment (p < 0.001) and differences corresponding to 32‒100% of the knee frontal moment and 21‒100% of the knee horizontal moment (p < 0.001). The GRF varied in the support zone at 44‒95% in the medial-lateral direction and at 17‒43% and 73‒100% in the vertical direction (p < 0.001).ConclusionsInjury prevention feedback reduced the load on the lower extremity joints during cutting maneuvers, which reduced the knee ligament load, mainly on the MCL.

Surgeon Factors Rather than Patient Factors Account for Variation in Recommended Treatment Strategy for Patients with Multi-ligament Knee Injury

Objectives: To seek the factors associated with timing, staging, and type of surgery in the management of multi-ligament knee injuries. Design: Cross-sectional scenario-based experiment. Setting: 15 fictional patient scenarios with randomized elements. Participants: Fracture surgeons of the Science of Variation Group, an international collaborative of musculoskeletal surgeons that studies variation in care, were invited to participate. Surgeons with limited experience treating multi-ligament knee injuries were asked to self-exclude. Outcome measures and comparisons: Surgeon recommendations for operative treatment, timing of surgery, and use of open surgery in addition to arthroscopy were measured. Patient factors (age, time from injury, contralateral fracture, knee dislocation, combinations of ruptured ligaments, pre-existing osteoarthritis) and surgeon factors (gender, practice location, years of experience, supervision of trainees) associated with surgeon recommendations were assessed. Results: Eighty-five surgeons participated, of which most were men (89%) and practiced in the United States (44%) or Europe (38%). Operative treatment was less likely among older patients (OR=0.051) and pre-existing osteoarthritis (OR=0.32), and more likely in knee dislocation (OR=1.9) and disruption of anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), and lateral collateral ligament (LCL) with or without medial collateral ligament (MCL; OR=5.1 and OR=3.1, respectively). Disruption of ACL, PCL, and MCL was associated with shorter time to surgery (β=-11). Longer time to surgery was associated with contralateral fracture (β=9.2), and surgeons supervising trainees (β=23) and practicing in Europe (β=13). Surgeon factors accounted for more variation in timing than patient and injury factors (5.1% vs 1.4%, respectively). Open surgery was more likely in patients with LCL injury (OR=2.9 to 3.3). Conclusion: The observation that surgeons were more likely to operate in younger patients with more severe injury has face validity, while the finding that surgeon factors accounted for more variation in timing of surgery than patient or injury factors suggests that treatment variation is based on opinion more so than evidence. Level of Evidence: Level III. See Instructions for Authors for a complete description of levels of evidence.

Ex vivo evaluation of the soft tissue components of the equine stifle using 3 Tesla magnetic resonance imaging under flexion, extension, and loading.

High-field MRI of the equine stifle provides high-resolution information about soft tissues that is useful in the diagnosis of stifle lameness. The aim of this prospective anatomic study was to describe the appearance, position, size, and shape of the equine femorotibial ligaments, meniscal ligaments, and menisci using 3 Tesla MRI under extended, extended-loaded, and flexed conditions. Additionally, histologic examination of the collateral and cruciate ligaments (CLs) of a single stifle was performed to compare with MRI images. In extension, mild variations in MRI signal intensity were apparent in the CLs, and the cranial had two distinct longitudinal regions indicating two ligament bundles. Flexion had minor effects on CL signal intensity and altered the tibial angles of attachment. Histology indicated that both CLs were comprised of two fiber bundles. The collateral ligaments were the same low-signal intensity. The medial collateral ligament had a smaller cross-sectional area than the lateral, and flexion increased the length of the medial collateral ligament and the cross-sectional area of the lateral. Low loads in extension did not affect the MRI appearance of stifle soft tissues. Flexion of the stifle impacted cruciate ligament insertion angles and the size and shape of collateral ligaments. This study provides support for the use of MRI to understand the anatomy and function of stifle ligaments.