BJECTIVE: To study the effect of transposition of great adductor muscular tendon pedicled vessels in repairing the medial collateral ligament defect of knee joint. METHODS: From September 1991 to September 1999, on the basis study of applied anatomy, 30 patients with the medial collateral ligament defect were repaired with great adductor muscular tendon transposition pedicled vessels. Among them, there were 28 males and 2 females, aged 26 years in average. RESULTS: Followed up for 17 to 60 months, 93.3% patients reached excellent or good grades. No case fell into the poor grade. CONCLUSION: Because the great adductor muscular tendon is adjacent to the knee joint and similar to the knee ligament, it is appropriate to repair knee ligament. Transposition of the great adductor muscular tendon pedicled vessels is effective in the reconstruction of the medial collateral ligament defect of knee joint.
ObjectiveTo investigate effect of posterior oblique ligament (POL) repair on the rotational stability of the knee joint for the medial collateral ligament (MCL) combined with anterior cruciate ligament (ACL) ruptures.MethodsThe clinical data of 50 patients (50 knees) with grade-3 MCL-ACL combined injuries who met the selection criteria between January 2013 and December 2015 were retrospectively analyzed. All ACLs were reconstructed with autogenous tendon and the superficial and deep layers of MCLs were sutured; then, POLs were also sutured in 25 patients of repair group and only received conservation treatment postoperatively in 25 patients of conservation group. There was no significant difference in gender, age, disease duration, and preoperative KT-1000 measuring, medial joint space opening, International Knee Documentation Committee (IKDC) score, visual analogue scale (VAS) score, and knee range of motion between the two groups (P>0.05).ResultsAll incisions of the two groups healed by first intention, no surgical related complications occurred. All patients were followed up, with follow-up time of 28-56 months (mean, 38.1 months) in repair group and 26-55 months (mean, 29.1 months) in conservation group. At last follow-up, the IKDC score, VAS score, KT-1000 measuring, medial joint space opening, and knee range of motion significantly improved in the two groups when compared with preoperative ones (P<0.05); but there was no significant difference between the two groups (P>0.05). The Slocum test showed that there was no instability of the anterior medial rotation in the two groups.ConclusionThe POL repair can’t obtain more medial stability after ACL reconstruction and MCL repair (superficial and deep layers) for patients who have MCL-ACL combined injuries.
Objective To examine an effect of the locally-used platelet derived growth factor-BB (PDGF-BB) on the healing of the medial collateral ligament (MCL) in the knee joints of rats. Methods Forty-eight rats were equally randomly divided into 2 groups: the experimental group (group A) and the control group(group B). MCL of all the rats were ruptured to establish the wound models. In group A, 5 μg of PDGF-BB was locally injected in the wound of each rat and then the wound was sutured; but in group B, the wound was only sutured. After 2 weeks, histological evaluations were performed to determine whether PDGF-BB could promote the healing of MCL. Results There were significantly more fibroblasts formed during the ligament healing process in group A than in group B (213.44±15.32 vs. 180.42±12.78, Plt;0.01). The fibroblasts were more mature andmore regularlyarranged in group A than in group B. The type, content, and crosslink of the collagen were improved to a greater extent in group A than in group B (Plt;0.01). Conclusion PDGF can promote the healing of the injured ligament.
Objective To observe the effectiveness of the combination of dynamic and static stabil ity in the treatment of old knee medial collateral l igament injury. Methods Between March 2004 and June 2008, 26 cases of old knee medial collateral l igament injury were treated, including 19 males and 7 females with a mean age of 38 years (range, 21-48 years). Injury was caused by traffic accident in 6 cases, by sprains in 12 cases, by fall ing from height in 8 cases. The location was left knee in 15 cases and right knee in 11 cases. Of them, 24 patients showed the positive result of knee valgus test, 2 cases showed sl ightly relaxed knee tendon. The knee X-ray films of valgus stress position showed that the medial joint space differences between both knees were 3-5 mm in 2 cases and 5-12 mm in 24 cases. The injuries included avulsion of the medial femoral condyle starting point in 19 cases, central laceration in 6 cases, and tibial point laceration concomitant meniscus injury in 1 case. The time from injury to hospital ization was 3-14 months (mean, 6.4 months). Gracil is muscle was used to repair knee medial collateral l igament and the sartorius muscle transfer to reconstruct the medial rotation of knee stabil ity function. Results All incisions healed by first intention. No joint infection, deep vein thrombosis, or other postoperative compl ications occurred. Twentysix cases were followed up 12-58 months with an average of 30 months. The results of knee valgus stress test were negative with no joint tenderness. At 3 months after operation, the knee X-ray films of valgus stress position showed the medial joint space differences between both knees were less than 1 mm. According to the modified Lysholm-Scale score, the results were excellent in 18 cases, good in 7 cases, and fair in 1 case with an excellent and good rate of 96% at last follow-up. Conclusion A combination of dynamic and static stabil ity in repairing old knee medial collateral l igament injury is easy-to-operate and has the advantages to perform the operation in the same incision, so it can avoid the shortcomings of single repair method and achieve better effectiveness.
ObjectiveTo compare the effectiveness of transosseous tunnel fixation and drilling fixation for repair of lateral collateral ligament complex (LCLC) in treatment of terrible triad of elbow (TTE).MethodsA clinical data of 50 patients with TTE between June 2012 and January 2018 were retrospectively analyzed. The LCLC was repaired with transosseous tunnel fixation in 22 patients (transosseous tunnel fixation group) and with drilling fixation in 28 patients (drilling fixation group). There was no significant difference between the two groups (P>0.05) in gender, age, fracture side, time from injury to admission, coronoid process fracture classification, radial head fracture classification, and TTE classification. The operation time, intraoperative blood loss, fracture healing time, and complications of the two groups were recorded. At last follow-up, the Mayo elbow performance system (MEPS) score, range of motion of elbow joint, and Broberg-Morrey classification were recorded.ResultsThe operation of two groups were successfully completed. There was no significant difference in the operation time and intraoperative blood loss between the two group (P>0.05). The follow-up time was (24.43±6.84) months in the transosseous tunnel fixation group and (21.55±6.16) months in the drilling fixation group, and the difference was not significant (t=1.534, P=0.132). X-ray films showed that the coronoid process and radial head fractures in the two groups healed, and there was no significant difference in the healing time (P>0.05). At last follow-up, there was no significant difference in the flexion-extension activity, rotation activity, MEPS score, and Broberg-Morrey grading (P>0.05). During the follow-up, there was no re-dislocation or instability of the elbow joint. The incidence of complication was 28.57% (8/28) in the transosseous tunnel fixation group and 27.27% (6/22) in the drilling fixation group, showing no significant difference (χ2=2.403, P=0.121).ConclusionBoth transosseous tunnel fixation and drilling fixation can achieve good results in repair of LCLC for TTE.
ObjectiveTo compare the clinical efficacy between deep medial collateral ligament (dMCL) repair and conservative treatment for complete MCL rupture. MethodsBetween August 2009 and December 2013, 36 patients with grade 3 MCL rupture underwent superior MCL (sMCL) reconstruction with tibial Inlay technique. Of 36 cases, 19 received dMCL repair (repair group), and 17 received conservative treatment (conservation group) after sMCL reconstruction. There was no significant difference in gender, age, knee sides, type of injury, disease duration and preoperative medial joint opening, knee Lysholm scores, and International Knee Documentation Committee (IKDC) score between 2 groups (P > 0.05). The Lysholm and IKDC scores, medial joint opening, range of motion (ROM), visual analogue scale (VAS) scores, and complications were used to assess the knee joint function. ResultsAll patients achieved primary incision healing without acute postoperative complications of incision infection and deep vein thrombosis in the lower limb. The patients were followed up 28-65 months (mean, 46.3 months) in the repair group, and 26-69 months (mean, 45.9 months) in the conservation group. No knee stiffness, vascular or nerve injury, and knee joint infection occurred in 2 groups. All the patients recovered medial stability at 2 years postoperatively. At 2 years after operation, no significant difference was shown in knee ROM between 2 groups (t=0.26, P=0.80); the VAS score of the repair group was significantly lower than that of the conservation group (t=5.22, P=0.00); medial joint opening, IKDC score, and Lysholm score were significantly improved when compared with preoperative ones in 2 groups (P < 0.05), but no significant difference was found between 2 groups (P>0.05). ConclusionWhether or not additional dMCL repair is performed can recover medial stability after sMCL reconstruction. However, the additional dMCL repair is better in relieving medial knee pain than the conservative treatment.
ObjectiveTo summarize the prevention and treatment of iatrogenic medial collateral ligament (MCL) injuries in total knee arthroplasty (TKA).MethodsThe relevant literature about iatrogenic MCL injuries in TKA was summarized, and the symptoms, causes, preventions, and treatments were analyzed.ResultsPreventions on the iatrogenic MCL injuries in TKA is significantly promoted. With the occurrence of MCL injuries, the femoral avulsion can be fixed with the screw and washer or the suture anchors; the tibial avulsion can be treated with the suture anchors fixation, bone staples fixation, or conservative treatment; the mid-substance laceration can be repaired directly; the autologous quadriceps tendon, semitendinosus tendon, or artificial ligament can be used for the patients with poor tissue conditions or obvious residual gap between the ligament ends; the use of implant with greater constraint can be the last alternative method.ConclusionNo consensus has been reached to the management of iatrogenic MCL injuries in TKA. Different solutions and strategies can be integrated and adopted flexibly by surgeons according to the specific situation.
Objective To investigate whether the outlet of the femoral tunnel will cause iatrogenic injury to the medial collateral ligament (MCL) during posterior cruciate ligament reconstruction (PCLR) and estimate the safe angle of femoral tunnel placement. MethodsThirteen formaldehyde-soaked human knee joint specimens were used, 8 from men and 5 from women; the donors’ age ranged from 49 to 71 years, with an average of 61 years. First, the medial part of the femur was carefully dissected to clearly expose the region of the MCL course and attachment on the femoral medial aspect and to outline the anterior margin of the region with a marked line. The marked line divided the medial femoral condyle into an area with an MCL course and a bare bone area which is regarded relatively safe for no MCL course. Then, the posterior cruciate ligament (PCL) was cut to identify the femoral attachment of the PCL. After the knee joint was fixed at a 120° flexion angle, the process of femoral tunnel preparation for the PCL single-bundle reconstruction was simulated. The inside-out technique was used to drill the femoral tunnel from the PCL femoral footprint inside the knee joint with an orientation to exit the medial condyle of the femur, and the combination angle of the two planes, the axial plane and the coronal plane, was adapted to the process of drilling femoral tunnels at different orientations. The following 15 angle combinations were used in the study: 0°/30°, 0°/45°, 0°/60°, 15°/30°, 15°/45°, 15°/60°, 30°/30°, 30°/45°, 30°/60°, 45°/30°, 45°/45°, 45°/60°, 60°/30°, 60°/45°, 60°/60° (axial/coronal). The positional relationship between the femoral tunnel outlet on the femoral medial condyle and the marked line was used to verify whether the tunnel drilling angle was a risk factor for MCL injury or not, and whether the shortest distance between the femoral exit center and the marked line was affected by the various angle combinations. Furthermore, the safe orientation of the femoral tunnel placement would estimated. ResultsWhen creating the femoral tunnel for PCLR, there was a risk of damage to the MCL caused by the tunnel outlet, and the incidence was from 0 to 100%; when the drilling angle of the axial plane was 0° and 15°, the incidence of MCL damage was from 69.23% to 100%. There was a significant difference in the incidence of MCL damage among femoral tunnels of 15 angle combinations (χ2=148.195, P<0.001). By comparison between groups, it was found that when drilling femoral tunnels at 5 combinations of 45°/45°, 45°/60°, 60°/30°, 60°/45°, and 60°/60° (axial/coronal), the shortest distances between the tunnel exit and the marked line were significantly different than 0°/45°, 0°/60°, 15°/45°, 15°/60°, and 30°/30° (axial/coronal) (P<0.05). Additionally, after comparing the median of the shortest distance with other groups, the outlets generated by these 5 angles were farther from the marked line and the posterior MCL. ConclusionThe creation of the femoral tunnel in PCLR can cause iatrogenic MCL injury, and the risk is affected by the tunnel angle. To reduce the risk of iatrogenic injury, angle combinations of 45°/45°, 45°/60°, 60°/30°, 60°/45°, and 60°/60° (axial/coronal) are recommended for preparing the femoral tunnel in PCLR.
Objective To discuss the effectiveness of operation technique for antero-medial rotatory instability (AMRI) of the knee joint caused by motorcycle. Methods Between June 2007 and December 2009, 32 cases of AMRI caused by motorcycle were treated. There were 28 males and 4 females with an average age of 35.5 years (range, 20-50 years). The interval between injury and surgery was 5-10 days (mean, 7 days). The anterior cruciate ligament (ACL) was injured at the attachment point of the condyles crest; the medial collateral ligament (MCL) was injured at central site in 19 cases, at medial condyles of femur in 10 cases, and at medial condyles of tibia in 3 cases, which were all closed injuries. The bone avulsion of condyles crest was fixed by steel wire and MCL was repaired. Results Red swelling and a little effusion occurred at the incision in 1 case, and the other incisions healed by first intention. Traumatic arthritis of the knee occured in 5 cases. Thirty-two cases were followed up 16-22 months (mean, 18.5 months). The X-ray examination showed that the fracture union time was 5-8 weeks (mean, 6 weeks) after operation. At last follow-up, the extension of knee joint was 0° and the flexion of the knee joint was 110-170° (mean, 155°). According to the synthetic evaluating standard of International Knee Documentation Committee, 24 cases were rated as A level, 6 cases as B, 1 case as C, and 1 case as D at last follow-up. Lysholm knee score was 85.93 ± 3.76 at last follow-up, which was significantly higher (t=53.785, P=0.000) than preoperative score 37.54 ± 3.43. Conclusion In patients with AMRI caused by motorcycle, steel wire is used to fix the bone avulsion of condyles crest and MCL should be repaired simultaneously as far as possible. And associating with the early postoperative functional exercise, the short-term effectiveness is satisfactory, but long-term effectiveness still need further follow-up observation.
Objective To evaluate of the valgus stability of the elbow after excision of the radial head, release of the medial collateral ligament (MCL), radial head replacement, and medial collateral ligament reconstruction.Methods Twelve fresh human cadaveric elbows were dissected to establish 7 kinds of specimens with elbow joint and ligaments as follow:①intact(n=12)； ②release of the medial collateral ligament(n=6)；③ excision of the radial head(n=6)；④excision of the radial head together with release of the medial collateral ligament(n=12)；⑤radial head replacement(n=6)；⑥medial collateral ligament reconstruction(n=6)；⑦radial head replacement together with medial collateral ligament reconstruction(n=12). Under two-newton-meter valgus torque, and at 0, 30, 60, 90 and 120 degrees of flexion with the forearm in supination, the valgus elbow laxity was quantified: All analysis was performed with SPSS 10.0 software.Results The least valgus laxity was seen in the intact state and its stability was the best. The laxity increased after resection of the radial head. The laxity was more after release of the medial collateral ligament than after resection of the radial head (Plt;0.01). The greatest laxity was observed after release of the medial collateral ligament together with resection of the radial head, so its stability was the worst. The laxity of the following implant of the radial head decreased. The laxity of the medial collateral ligament reconstruction was as much as that of the intact ligament (Pgt;0.05). The laxity of the radial head replacement together with medial collateral ligament reconstruction became less.Conclusion The results of this studyshow that the medial collateral ligament is the primary valgus stabilizer of the elbow and the radial head was a secondary constraint to resist valgus laxity.Both the medial collateral ligament reconstruction and the radial head replacement can restore the stability of elbow. If the radial head replacement can notbe carried out, the reconstruction of the medial collateral ligament is acceptable.