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Anatomic medial complex reconstruction in serious medial knee instability results in excellent mid-term outcomes

  • Dhong Won Lee
  • Jin Goo KimEmail author
KNEE
  • 14 Downloads

Abstract

Purpose

To evaluate the mid-term outcomes of anatomic medial complex reconstruction in cases of serious medial knee instability.

Methods

Between 2010 and 2013, 23 patients who underwent anatomic medial complex reconstruction with a minimum 5-year follow-up were included. The Lysholm score, International Knee Documentation Committee subjective knee form (IKDC SKF), and Tegner activity scale scores were evaluated. Clinical and functional tests included valgus and sagittal stress tests, isokinetic muscle strength test, single leg hop for distance test (SLDT), and single leg vertical jump test (SLVT).

Results

The mean follow-up duration was 77.2 ± 10.8 months. At final follow-up, the Lysholm score improved from 49.7 ± 10.2 to 93.4 ± 12.4; the IKDC SKF score, from 46.2 ± 8.7 to 90.5 ± 13.9; and median Tegner activity, from 5 (4–7) to 7 (4–10) (P < 0.001). The mean side-to-side difference on valgus stress radiographs was significantly reduced to 1.2 ± 0.7 mm postoperatively compared to 8.5 ± 1.6 mm preoperatively (P < 0.001). The mean side-to-side differences on anterior and posterior stress radiographs were significantly improved in concomitant ACL and PCL reconstructions, respectively (P < 0.001). Preoperatively, 17 patients (73.9%) had anteromedial rotatory instability (AMRI), but none had AMRI at the last follow-up. The extensor peak torque and Limb Symmetry Index (LSI, %) improved from 128.2 ± 42.9 to 225 ± 39.4 N m/kg and from 61.4 ± 19.6 to 88.7 ± 21.7%, respectively (P < 0.001). The LSI (%) for SLDT and SLVT improved from 56.8 ± 19.5 to 87.3 ± 14.2% and from 68.1 ± 21.1 to 91.1 ± 12.8%, respectively (P < 0.001). No patient had a restricted range of movement.

Conclusion

Although posteromedial corner injuries that need medial complex reconstruction are extremely rare, proper anatomic medial complex reconstruction of the medial collateral and posterior oblique ligaments achieved satisfactory clinical and functional outcomes at mid-term follow-up in cases with chronic symptomatic valgus and rotatory laxity.

Level of evidence

Case series, level IV.

Keywords

Multiple ligament injuries Medial collateral ligament Chronic valgus instability Medial collateral ligament reconstruction 

Notes

Funding

No external funding was used.

Compliance with ethical standards

Conflict of interest

There are no conflicts of interest.

Ethical approval

This study was performed with the approval of the ethics committee of Konkuk University Medical Center (KUH1060156).

References

  1. 1.
    Bonasia DE, Bruzzone M, Dettoni F, Marmotti A, Blonna D, Castoldi F et al (2012) Treatment of medial and posteromedial knee instability: indications, techniques, and review of the results. Iowa Orthop J 32:173–183Google Scholar
  2. 2.
    DeLong JM, Waterman BR (2015) Surgical techniques for the reconstruction of medial collateral ligament and posteromedial corner injuries of the knee: a systematic review. Arthroscopy 31:2258–2272 (e2251) CrossRefGoogle Scholar
  3. 3.
    Dold AP, Swensen S, Strauss E, Alaia M (2017) The posteromedial corner of the knee: anatomy, pathology, and management strategies. J Am Acad Orthop Surg 25:752–761CrossRefGoogle Scholar
  4. 4.
    Dong J, Wang XF, Men X, Zhu J, Walker GN, Zheng XZ et al (2015) Surgical treatment of acute grade III medial collateral ligament injury combined with anterior cruciate ligament injury: anatomic ligament repair versus triangular ligament reconstruction. Arthroscopy 31:1108–1116CrossRefGoogle Scholar
  5. 5.
    Dong JT, Chen BC, Men XQ, Wang F, Hao JD, Zhao JN et al (2012) Application of triangular vector to functionally reconstruct the medial collateral ligament with double-bundle allograft technique. Arthroscopy 28:1445–1453CrossRefGoogle Scholar
  6. 6.
    Engebretsen L, Lind M (2015) Anteromedial rotatory laxity. Knee Surg Sports Traumatol Arthrosc 23:2797–2804CrossRefGoogle Scholar
  7. 7.
    Frank CB (2004) Ligament structure, physiology and function. J Musculoskelet Neuronal Interact 4:199–201Google Scholar
  8. 8.
    Hiemstra LA, Webber S, MacDonald PB, Kriellaars DJ (2007) Contralateral limb strength deficits after anterior cruciate ligament reconstruction using a hamstring tendon graft. Clin Biomech (Bristol Avon) 22:543–550CrossRefGoogle Scholar
  9. 9.
    Hopper DM, Goh SC, Wentworth LA, Chan DYK, Chau JHW, Wootton GJ et al (2002) Test–retest reliability of knee rating scales and functional hop tests one year following anterior cruciate ligament reconstruction. Phys Ther Sport 3:10–18CrossRefGoogle Scholar
  10. 10.
    Kim SJ, Lee DH, Kim TE, Choi NH (2008) Concomitant reconstruction of the medial collateral and posterior oblique ligaments for medial instability of the knee. J Bone Jt Surg Br 90:1323–1327CrossRefGoogle Scholar
  11. 11.
    LaPrade MD, Kennedy MI, Wijdicks CA, LaPrade RF (2015) Anatomy and biomechanics of the medial side of the knee and their surgical implications. Sports Med Arthrosc Rev 23:63–70CrossRefGoogle Scholar
  12. 12.
    Laprade RF, Bernhardson AS, Griffith CJ, Macalena JA, Wijdicks CA (2010) Correlation of valgus stress radiographs with medial knee ligament injuries: an in vitro biomechanical study. Am J Sports Med 38:330–338CrossRefGoogle Scholar
  13. 13.
    LaPrade RF, Engebretsen AH, Ly TV, Johansen S, Wentorf FA, Engebretsen L (2007) The anatomy of the medial part of the knee. J Bone Jt Surg Am 89:2000–2010Google Scholar
  14. 14.
    Laprade RF, Wijdicks CA (2012) Surgical technique: development of an anatomic medial knee reconstruction. Clin Orthop Relat Res 470:806–814CrossRefGoogle Scholar
  15. 15.
    Lee DW, Yang SJ, Cho SI, Lee JH, Kim JG (2018) Single-leg vertical jump test as a functional test after anterior cruciate ligament reconstruction. Knee 25:1016–1026CrossRefGoogle Scholar
  16. 16.
    Lind M, Jakobsen BW, Lund B, Hansen MS, Abdallah O, Christiansen SE (2009) Anatomical reconstruction of the medial collateral ligament and posteromedial corner of the knee in patients with chronic medial collateral ligament instability. Am J Sports Med 37:1116–1122CrossRefGoogle Scholar
  17. 17.
    Liu H, Wang F, Kang H, Chen B, Zhang Y, Ma L (2012) Anatomical reconstruction of the medial collateral ligament and the posterior oblique ligament of the knee. Acta Orthop Belg 78:400–404Google Scholar
  18. 18.
    Noyes FR, Barber SD, Mangine RE (1991) Abnormal lower limb symmetry determined by function hop tests after anterior cruciate ligament rupture. Am J Sports Med 19:513–518CrossRefGoogle Scholar
  19. 19.
    Robinson JR, Sanchez-Ballester J, Bull AM, Thomas Rde W, Amis AA (2004) The posteromedial corner revisited. An anatomical description of the passive restraining structures of the medial aspect of the human knee. J Bone Jt Surg Br 86:674–681CrossRefGoogle Scholar
  20. 20.
    Sims WF, Jacobson KE (2004) The posteromedial corner of the knee: medial-sided injury patterns revisited. Am J Sports Med 32:337–345CrossRefGoogle Scholar
  21. 21.
    Stannard JP (2010) Medial and posteromedial instability of the knee: evaluation, treatment, and results. Sports Med Arthrosc Rev 18:263–268CrossRefGoogle Scholar
  22. 22.
    Tandogan NR, Kayaalp A (2016) Surgical treatment of medial knee ligament injuries: current indications and techniques. EFORT Open Rev 1:27–33CrossRefGoogle Scholar
  23. 23.
    Tsepis E, Vagenas G, Giakas G, Georgoulis A (2004) Hamstring weakness as an indicator of poor knee function in ACL-deficient patients. Knee Surg Sports Traumatol Arthrosc 12:22–29CrossRefGoogle Scholar
  24. 24.
    Varelas AN, Erickson BJ, Cvetanovich GL, Bach BR Jr (2017) Medial collateral ligament reconstruction in patients with medial knee instability: a systematic review. Orthop J Sports Med 5:2325967117703920CrossRefGoogle Scholar

Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2019

Authors and Affiliations

  1. 1.Department of Orthopaedic SurgeryKonKuk University Medical CenterSeoulSouth Korea

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