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Medial Collateral Ligament Laxity in Revision ACL Reconstruction

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Abstract

The medial collateral ligament (MCL) is the primary restraint to valgus stability of the knee. Familiarity with the anatomy of this ligament alongside with recognizing and addressing dysfunction of this structure in the setting of ACL reconstruction is of major importance, and failure to do so can result in excessive valgus stress applied to the ACL graft, leading to graft failure. Assessment of MCL function should begin with history, a thorough physical examination including alignment and gait, and then a detailed evaluation of all knee ligaments. Stress radiographs can be performed in selected cases to further assess medial gapping. Evaluation under anesthesia is then undertaken when surgery is indicated, followed by arthroscopic evaluation to assess the amount of medial compartment gapping.

Surgical techniques to address medial side dysfunction in scenarios of ACL reconstruction surgery include medial side plication when the amount of medial compartment opening is less than 10 mm, but reconstruction is advisable when medial side opening is measured 10 mm or more. Multiple techniques for reconstructing the medial stabilizing complex have been described, including autograft as well as allograft type of tissue. Cases that involve valgus malalignment with the appearance of valgus-thrust gait should not be overlooked, since correcting the alignment with an osteotomy should be considered as the first surgical step.

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References

  1. Grood ES, Noyes FR, Butler DL, Suntay WJ. Ligamentous and capsular restraints preventing straight medial and lateral laxity in intact human cadaver knees. J Bone Joint Surg Am. 1981;63: 1257–69.

    PubMed  CAS  Google Scholar 

  2. Larson RL. Combined instabilities of the knee. Clin Orthop Relat Res. 1980;147:68–75.

    PubMed  Google Scholar 

  3. Inoue M, McGurk-Burleson E, Hollis JM, Woo SL. Treatment of the medial collateral ligament injury. I: the importance of anterior cruciate ligament on the varus-valgus knee laxity. Am J Sports Med. 1987;15: 15–21.

    Article  PubMed  CAS  Google Scholar 

  4. La Prade RF, Engebretsen AH, Ly TV, Johansen S, Wentorf FA, Engebretsen L. The anatomy of the medial part of the knee. J Bone Joint Surg Am. 2007;89:2000–10.

    Article  Google Scholar 

  5. Phisitkul P, Wolf BR, Amendola A. Role of high tibial and distal femoral osteotomies in the treatment of lateral-posterolateral and medial instabilities of the knee. Sports Med Arthrosc. 2006;14:96–104.

    Article  PubMed  Google Scholar 

  6. Fanelli GC, Harris JD. Late medial collateral ligament reconstruction. Tech Knee Surg. 2007;6:99–105.

    Article  Google Scholar 

  7. Hughston JC, Eilers AF. The role of the posterior oblique ligament in repairs of acute medial (collateral) ligament tears of the knee. J Bone Joint Surg Am. 1973;55:923–40.

    PubMed  CAS  Google Scholar 

  8. Wijdicks CA, Griffith CJ, Johansen S, Engebretsen L, La Prade RF. Injuries to the medial collateral ligament and associated medial structures of the knee. J Bone Joint Surg Am. 2010;92:1266–80.

    Article  PubMed  Google Scholar 

  9. LaPrade RF, Bernhardson AS, Griffith CJ, Macalena JA, Wijdicks CA. Correlation of valgus stress radiographs with medial knee ligament injuries: an in vitro biomechanical study. Am J Sports Med. 2010;38: 330–8.

    Article  PubMed  Google Scholar 

  10. Canata GL, Chiey A, Leoni T. Surgical technique: does mini-invasive medial collateral ligament and posterior oblique ligament repair restore knee stability in combined chronic medial and ACL injuries? Clin Orthop Relat Res. 2012;470:791–7.

    Article  PubMed  Google Scholar 

  11. Marx RG, Hetsroni I. Surgical technique: medial collateral ligament reconstruction using Achilles allograft for combined knee ligament injury. Clin Orthop Relat Res. 2012;470:798–805.

    Article  PubMed  Google Scholar 

  12. Robins AJ, Newman AP, Burks RT. Postoperative return of motion in anterior cruciate ligament and medial collateral ligament injuries: the effect of medial collateral ligament rupture locations. Am J Sports Med. 1993;21:20–5.

    Article  PubMed  CAS  Google Scholar 

  13. Azar FM. Evaluation and treatment of chronic medial collateral ligament injuries of the knee. Sports Med Arthrosc. 2006;14:84–90.

    Article  PubMed  Google Scholar 

  14. Bosworth DM. Transplantation of the semitendinosus for repair of laceration of medial collateral ligament of the knee. J Bone Joint Surg Am. 1952;34: 196–202.

    PubMed  Google Scholar 

  15. Kim SJ, Lee DH, Kim TE, Choi NH. Concomitant reconstruction of the medial collateral and posterior oblique ligaments for medial instability of the knee. J Bone Joint Surg Br. 2008;90:1323–7.

    PubMed  Google Scholar 

  16. Lind M, Jakobsen BW, Lund B, Hansen MS, Abdallah O, Christiansen SE. 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. 2009;37: 1116–22.

    Article  PubMed  Google Scholar 

  17. Borden PS, Kantaras AT, Caborn DNM. Medial collateral ligament reconstruction with allograft using a double-bundle technique. Arthroscopy. 2002;18:E19.

    Article  PubMed  Google Scholar 

  18. Fanelli GC, Tomaszewski DJ. Allograft use in the treatment of the multiple ligament injured knee. Sports Med Arthrosc. 2007;15:139–48.

    Article  PubMed  Google Scholar 

  19. Feeley BT, Muller MS, Allen AA, Granchi CC, Pearle AD. Biomechanical comparison of medial collateral ligament reconstructions using computer-assisted navigation. Am J Sports Med. 2009;37:1123–30.

    Article  PubMed  Google Scholar 

  20. Feeley BT, Muller MS, Allen AA, Granchi CC, Pearle AD. Isometry of medial collateral ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2009;17:1078–82.

    Article  PubMed  Google Scholar 

  21. Wijdicks CA, Griffith CJ, Johansen S, Engebretsen L, LaPrade RF. Injuries to the medial collateral ligament and associated medial structures of the knee. J Bone Joint Surg Am. 2010;92:1266–80.

    Article  PubMed  Google Scholar 

  22. Mitsou A, Vallianatos P, Piskopakis N, Maheras S. Anterior cruciate ligament reconstruction by over-the-top repair combined with popliteus tendon plasty. J Bone Joint Surg Br. 1990;72:398–404.

    PubMed  CAS  Google Scholar 

  23. Moller E, Weidenhielm L, Werner S. Outcome and knee-related quality of life after anterior cruciate ligament reconstruction: a long term follow-up. Knee Surg Sports Traumatol Arthrosc. 2009;17: 786–94.

    Article  PubMed  Google Scholar 

  24. Odensten M, Lysholm J, Gillquist J. Long-term follow-up study of a distal iliotibial band transfer (DIT) for anterolateral knee instability. Clin Orthop Relat Res. 1983;176:129–35.

    PubMed  Google Scholar 

  25. Battaglia II MJ, Cordasco FA, Hannafin JA, Rodeo SA, O’Brien SJ, Altchek DW, et al. Results of revision anterior cruciate ligament surgery. Am J Sports Med. 2007;35:2057–66.

    Article  PubMed  Google Scholar 

  26. Wright RW, Dunn WR, Amendola A, Andrish JT, Flanigan DC, Jones M, et al. MOON cohort. Anterior cruciate ligament revision reconstruction: two-year results from the MOON cohort. J Knee Surg. 2007;20:308–11.

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Orthopaedic Surgery, Meir General Hospital, Sapir Medical Center, Tsharnichovski Street 59, Kfar Saba, 44281, Israel

    Iftach Hetsroni MD

  2. Tel Aviv University, Tel Aviv, Israel

    Iftach Hetsroni MD

  3. Centre of Sports Traumatology, Koelliker Hospital, Corso Duca degli Abruzzi 30, Torino, 10129, Italy

    Gian Luigi Canata MD

  4. Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medical College, 535 East 70th Street, New York, NY, 10021, USA

    Robert G. Marx MD, MSc, FRCSC

Authors
  1. Iftach Hetsroni MD
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  2. Gian Luigi Canata MD
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  3. Robert G. Marx MD, MSc, FRCSC
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Correspondence to Iftach Hetsroni MD .

Editor information

Editors and Affiliations

  1. Orthopaedic Surgery, Hospital for Special Surgery Weill Cornell Medical College, New York, New York, USA

    Robert G. Marx

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Hetsroni, I., Canata, G.L., Marx, R.G. (2014). Medial Collateral Ligament Laxity in Revision ACL Reconstruction. In: Marx, R. (eds) Revision ACL Reconstruction. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-0766-9_19

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  • DOI: https://doi.org/10.1007/978-1-4614-0766-9_19

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  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-0765-2

  • Online ISBN: 978-1-4614-0766-9

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