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Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 12/2020

Open Access 01-12-2020 | KNEE

Length-change patterns of the medial collateral ligament and posterior oblique ligament in relation to their function and surgery

Authors: Lukas Willinger, Shun Shinohara, Kiron K. Athwal, Simon Ball, Andy Williams, Andrew A. Amis

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 12/2020

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Abstract

Purpose

To define the length-change patterns of the superficial medial collateral ligament (sMCL), deep MCL (dMCL), and posterior oblique ligament (POL) across knee flexion and with applied anterior and rotational loads, and to relate these findings to their functions in knee stability and to surgical repair or reconstruction.

Methods

Ten cadaveric knees were mounted in a kinematics rig with loaded quadriceps, ITB, and hamstrings. Length changes of the anterior and posterior fibres of the sMCL, dMCL, and POL were recorded from 0° to 100° flexion by use of a linear displacement transducer and normalised to lengths at 0° flexion. Measurements were repeated with no external load, 90 N anterior draw force, and 5 Nm internal and 5 Nm external rotation torque applied.

Results

The anterior sMCL lengthened with flexion (p < 0.01) and further lengthened by external rotation (p < 0.001). The posterior sMCL slackened with flexion (p < 0.001), but was lengthened by internal rotation (p < 0.05). External rotation lengthened the anterior dMCL fibres by 10% throughout flexion (p < 0.001). sMCL release allowed the dMCL to become taut with valgus rotation (p < 0.001). The anterior and posterior POL fibres slackened with flexion (p < 0.001), but were elongated by internal rotation (p < 0.001).

Conclusion

The structures of the medial ligament complex react differently to knee flexion and applied loads. Structures attaching posterior to the medial epicondyle are taut in extension, whereas the anterior sMCL, attaching anterior to the epicondyle, is tensioned during flexion. The anterior dMCL is elongated by external rotation. These data offer the basis for MCL repair and reconstruction techniques regarding graft positioning and tensioning.
Literature
1.
Andrews K, Lu A, Mckean L, Ebrahim N (2017) Review: medial collateral ligament injuries. J Orthop 14:550–554CrossRef
2.
Arms S, Boyle J, Johnson R, Pope M (1983) Strain measurement in the medial collateral ligament of the human knee: an autopsy study. J Biomech 16(7):491–496CrossRef
3.
Borden PS, Kantaras AT, Caborn DN (2002) Medial collateral ligament reconstruction with allograft using a double-bundle technique. Arthroscopy 18(4):E19CrossRef
4.
Cavaignac E, Carpentier K, Pailhe R, Luyckx T, Bellemans J (2015) The role of the deep medial collateral ligament in controlling rotational stability of the knee. Knee Surg Sports Traumatol Arthrosc 23(10):3101–3107CrossRef
5.
Coobs BR, Wijdicks CA, Armitage BM et al (2010) An in vitro analysis of an anatomical medial knee reconstruction. Am J Sports Med 38(2):339–347CrossRef
6.
DeLong JM, Waterman BR (2015) Surgical techniques for the reconstruction of the medial collateral ligament and posteromedial corner inuries of the knee: a systematic review. Arthroscopy 31:1172–2258
7.
Farahmand F, Senavongse W, Amis AA (1998) Quantitative study of the quadriceps muscles and trochlear groove geometry related to instability of the patellofemoral joint. J Orthop Res 16:136–143CrossRef
8.
Feeley BT, Muller MS, Allen AA, Granchi CC, Pearle AD (2009) Biomechanical comparison of medial collateral ligament reconstructions using computer-assisted navigation. Am J Sports Med 37(6):1123–1130CrossRef
9.
Feeley BT, Muller MS, Allen AA, Granchi CC, Pearle AD (2009) Isometry of medial collateral ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 17(9):1078–1082CrossRef
10.
Gardiner JC, Weiss JA, Rosenberg TD (2001) Strain in the human medial collateral ligament during valgus loading of the knee. Clin Orthop Relat Res 391:266–274CrossRef
11.
Griffith CJ, LaPrade RF, Johansen S, Armitage B, Wijdicks C, Engebretsen L (2009) Medial knee injury: part 1, static function of the individual components of the main medial knee structures. Am J Sports Med 37(9):1762–1770CrossRef
12.
Grood ES, Noyes FR, Butler DL, Suntay WJ (1981) Ligamentous and capsular restraints preventing straight medial and lateral laxity in intact human cadaver knees. J Bone Jt Surg Am 63:1257–1269CrossRef
13.
Hosseini A, Qi W, Tsai TY, Liu Y, Rubash H, Li G (2015) In vivo length change patterns of the medial and lateral collateral ligaments along the flexion path of the knee. Knee Surg Sports Traumatol Arthrosc 23(10):3055–3061CrossRef
14.
Kennedy JC, Fowler PJ (1971) Medial and anterior instability of the knee. An anatomical and clinical study using stress machines. J Bone Jt Surg Am 53(7):1257–1270CrossRef
15.
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(10):1323–1327CrossRef
16.
Kittl C, Halewood C, Stephen JM et al (2015) Length change patterns in the lateral extra-articular structures of the knee and related reconstructions. Am J Sports Med 43(2):354–362CrossRef
17.
Kwak SD, Ahmad CS, Gardner TR et al (2000) Hamstrings and iliotibial band forces affect knee kinematics and contact pattern. J Orthop Res 18(1):101–108CrossRef
18.
LaPrade RF, Engebretsen AH, Ly TV, Johansem S, Wentorf FA, Engebretsen L (2007) The anatomy of the medial part of the knee. J Bone Jt Surg Am 89:2000–2010CrossRef
19.
Laprade RF, Wijdicks CA (2012) Surgical technique: development of an anatomic medial knee reconstruction. Clin Orthop Relat Res 470(3):806–814CrossRef
20.
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(6):1116–1122CrossRef
21.
Narvani A, Mahmud T, Lavelle J, Williams A (2010) Injury of the proximal deep MCL—a problematical subgroup of injuries. J Bone Jt Surg Br 92:949–953CrossRef
22.
Park SE, DeFrate LE, Suggs JF, Gill TJ, Rubash HE, Li G (2005) The change in length of the medial and lateral collateral ligaments during in vivo knee flexion. Knee 12(5):377–382CrossRef
23.
Preiss A, Giannakos A, Frosch KH (2012) Minimally invasive augmentation of the medial collateral ligament with autologous hamstring tendons in chronic knee instability. Oper Orthop Traumatol 24(4–5):335–347CrossRef
24.
Rasenberg EI, Lemmens JA, van Kampen A et al (1995) Grading medial collateral ligament injury: comparison of MR imaging and instrumented valgus-varus laxity test-device. A prospective double-blind patient study. Eur J Radiol 21(1):18–24CrossRef
25.
Reider B (1996) Medial collateral ligament injuries in athletes. Sports Med 21(2):147–156CrossRef
26.
Robinson JR, Bull AM, Amis AA (2005) Structural properties of the medial collateral ligament complex of the human knee. J Biomech 38(5):1067–1074CrossRef
27.
Robinson JR, Bull AM, Thomas RR, Amis AA (2006) The role of the medial collateral ligament and posteromedial capsule in controlling knee laxity. Am J Sports Med 34(11):1815–1823CrossRef
28.
Robinson JR, Sanchez-Ballester J, Bull AM, Thomas 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(5):674–681CrossRef
29.
Slocum DB, Larson RL (1968) Rotatory instability of the knee. Its pathogenesis and a clinical test to demonstrate its presence. J Bone Jt Surg Am 50(2):211–225CrossRef
30.
Stephen JM, Lumpaopong P, Deehan DJ, Kader D, Amis AA (2012) The medial patellofemoral ligament: location of femoral attachment and `patterns resulting from anatomic and nonanatomic attachments. Am J Sports Med 40(8):1871–1879CrossRef
31.
Svantesson E, Senorski EH, Alentorn-Geli E et al (2019) Increased risk of ACL revision with non-surgical treatment of a concomitant medial collateral ligament injury: a study on 19,457 patients from the Swedish national knee ligament registry. Knee Surg, Sports Traumatol Arthrosc 27:2450–2459CrossRef
32.
Victor J, Wong P, Witvrouw E, Sloten JV, Bellemans J (2009) How isometric are the medial patellofemoral, superficial medial collateral, and lateral collateral ligaments of the knee? Am J Sports Med 37(10):2028–2036CrossRef
33.
Warren LF, Marshall JL, Girgis F (1974) The prime static stabilizer of the medial side of the knee. J Bone Jt Surg Am 56(4):665–674CrossRef
34.
Warren LF, Marshall JL (1979) The supporting structures and layers on the medial side of the knee: an anatomical analysis. J Bone Jt Surg Am 61(1):56–62CrossRef
35.
Wijdicks CA, Griffith CJ, Johansen S, Engebretsen L, LaPrade RF (2010) Injuries to the medial collateral ligament and associated medial structures of the knee. J Bone Jt Surg Am 92(5):1266–1280CrossRef
Metadata
Title
Length-change patterns of the medial collateral ligament and posterior oblique ligament in relation to their function and surgery
Authors
Lukas Willinger
Shun Shinohara
Kiron K. Athwal
Simon Ball
Andy Williams
Andrew A. Amis
Publication date
01-12-2020
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 12/2020
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-020-06050-0

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