Superficial Medial Collateral Ligament Release Research Articles

Result of posteromedial capsule and superficial medial collateral ligament release on gap and alignment in total knee arthroplasty in varusknee deformity by computer assisted surgery measurement: a retrospective stud

Soft tissue release and gap balancing in total knee arthroplasty (TKA) are important issue and lack of conclusive result. We performed posteromedial capsule (PMC) and superficial medial collateral ligament (sMCL) release by preservation of anterior attachment of pes anserine. Gaps and alignment were recorded by computer assisted surgery measurement.Results:T: The mean correction of varus deformity after PMC release and sMCL release were 4.88 ± 2.82° and 3.39 ± 1.7 respectively with the mean FC after PMC and sMCL release correction of 5.57 ± 3.5 and 1.34 ± 2.9° respectively. The mean medial gap changes on full extension after PMC and sMCL release was 1.83 ± 1.39 and 1.67 ± 1.04 mm. respectively with the mean medial gaps at 90 degree flexion after PMC and sMCL release changes of 0.73 ± 0.9 and 5.14 ± 2.11 mm. respectively. The mean lateral gap changes on extension after PMC and sMCL release were -1.3 ± 1.83 and -1.1 ± 1.6 mm. respectively with the mean lateral gaps at 90 degree flexion after PMC and sMCL release changes of -0.19 ± 1.03 and 0.06 ± 1.75 mm. here were 21 patients (16 female and 5 male) with mean age of 68 (48-78) years. The mean body mass index was 28.49 (20.70 – 39.95) kg/m2. The mean preoperative hip-knee-ankle angle was varus 8.12 (3.5-16.0) degrees with mean flexion contracture of 11.3 (3.5-16.0) degrees. Sixteen knees were implanted with Fixed bearing knee prosthesis and five knees were implanted with Mobile bearing knee prosthesis (Table.1). We performed PMC release in all patients, and combined PMC and sMCL release in fourteen patients. The mean correction of varus deformity after PM release and sMCL release were 4.88 ± 2.82 and 3.39 ± 1.7 degrees respectively. While the mean correction of flexion contracture after PMC release and sMCL release were 5.57 ± 3.5 and 1.34 ± 2.9 degrees respectively (Fig.8). The mean medial gaps change on extension after PMC and sMCL release were 1.83 ± 1.39 and 1.67 ± 1.04 mm. respectively. The mean medial gaps change at 90 degree flexion after PMC and sMCL release were 0.73 ± 0.9 and 5.14 ± 2.11 mm. respectively (Fig.9). The mean lateral gaps change on extension after PMC and sMCL release were 1.3 ± 1.83 and -1.1 ± 1.6 mm. respectively. The mean lateral gaps change at 90 degree flexion after PMC and sMCL release were -0.19 ± 1.03 and 0.06 ± 1.75 mm. (Fig.9). There is no instability of knee after PMC and sMCL release.Materials and Methods:Twenty one patient had been operated on. TKA with computer assisted surgery was performed using PMC and sMCL release by preservation of anterior attachment of pes anserine. Alignment, medial and lateral gaps were measured by computer assisted surgery. The mean age was 68 (48-78) years with the mean preoperative hip-kneeankle angle of 8.12 (3.5-16.0) degrees and the mean flexion contracture (FC) of 11.3 (3.516.0) degrees.Conclusion:We believe that sMCL release with preservation of anterior attachment of pes anserinus in total knee arthroplasty has additional effect on varus knee correction after PMC release without creation of knee instability.

Suture Anchor Repair for a Medial Meniscus Posterior Root Tear Combined With Arthroscopic Meniscal Centralization and Open Wedge High Tibial Osteotomy

Medial meniscus posterior root tear (MMPRT) is now attracting increased attention as a risk factor for the development of osteoarthritis. However, the healing rate after root repair by the suture anchor technique or the pull-out technique is still low. Here we report on a technique of MMPRT repair using suture anchor combined with arthroscopic meniscal centralization and open wedge high tibial osteotomy (OWHTO). The purposes of this technique are (1) to distribute the meniscal hoop tension between the root repair site and the centralization site and (2) to reduce the load on medial meniscus by OWHTO. The routine exposure for OWHTO with superficial medial collateral ligament release creates good visualization for arthroscopic root repair. The first anchor is inserted on the medial edge of the medial tibial plateau, and the second anchor is inserted on the root attachment through a posteromedial portal. After tying the knots, OWHTO could be performed without interference between the suture anchors and the screws of the plate for fixing the osteotomy. Although further follow-up is required, this technique could improve the outcomes after root repair, as well as have some technical advantages.

Soft Tissue Balancing of Varus Arthritic Knee in Minimally Invasive Surgery Total Knee Arthroplasty: Comparison between Posterior Oblique Ligament Release and Superficial MCL Release

PurposeTo assess proper soft tissue balancing of the varus arthritic knee between posterior oblique ligament (POL) release group and superficial medial collateral ligament (SMCL) release group.Materials and MethodsThis retrospective study was performed on 186 patients who underwent minimally invasive surgery (MIS) total knee arthroplasty (TKA) from January 2011 to December 2011. Eighty-three patients were in the group of SMCL release and 103 patients were in the POL release group. We intended to use a 10 mm polyethylene insert (PE) during TKA, and retrospectively compared the actual thickness of PE between POL release group and SMCL release group.ResultsThe mean PE thickness was 10.59±1.3 mm (range, 8 to 15 mm) in POL group and 11.88±1.8 mm (range, 10 to 18 mm) in SMCL group (p=0.001). We found a significant difference in the mean PE thickness between POL release group and SMCL release group.ConclusionsPOL and deep MCL releases in MIS-TKA would be beneficial for varus deformity correction in the osteoarthritic knee.

Combined medial meniscal transplantation and high tibial osteotomy

This study describes a new surgical technique for combined medial meniscal transplantation and opening wedge high tibial osteotomy for meniscal-deficient knees with malalignment. The technique allows wider medial joint opening, better visualization of the medial compartment as well as easier meniscal graft positioning and suturing. This is achieved by transplanting the meniscus after superficial medial collateral ligament release and before osteotomy opening and fixation.

Quantification of Effect of Sequential Posteromedial Release on Flexion and Extension Gaps: A Computer-Assisted Study in Cadaveric Knees

A novel sequence of posteromedial release consistent with surgical technique of total knee arthroplasty was performed in 15 cadaveric knees. Medial and lateral flexion and extension gaps were measured after each step of the release using a computed tomography–free computer navigation system. A spring-loaded distractor and a manual distractor were used to distract the joint. Posterior cruciate ligament release increased flexion more than extension gap; deep medial collateral ligament release had a negligible effect; semimembranosus release increased the flexion gap medially; reduction osteotomy increased medial flexion and extension gaps; superficial medial collateral ligament release increased medial joint gap more in flexion and caused severe instability. This sequence of release led to incremental and differential effects on flexion-extension gaps and has implications in correcting varus deformity.