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Published in: Clinical Orthopaedics and Related Research® 3/2012

01-03-2012 | Symposium: Complex Knee Ligament Surgery

Surgical Technique: Development of an Anatomic Medial Knee Reconstruction

Authors: Robert F. LaPrade, MD, PhD, Coen A. Wijdicks, PhD

Published in: Clinical Orthopaedics and Related Research® | Issue 3/2012

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Abstract

Background

The main static stabilizers of the medial knee are the superficial medial collateral and posterior oblique ligaments. A number of reconstructive techniques have been advocated including one we describe here. However, whether these reconstructions restore function and stability is unclear.

Description of Technique

This anatomic reconstruction technique consisted of reconstruction of the proximal and distal divisions of the superficial medial collateral and the posterior oblique ligament using two separate grafts.

Patients and Methods

We prospectively followed all 28 patients (19 male, nine females) who had this new reconstruction between 2007 and 2009. The average age was 32.4 years (range, 16–56 years). There were eight acute and 20 chronic injuries. All patients presented with side-to-side instability with activities of daily living and other higher level activities. Minimum followup was 6 months (average, 1.5 years; range, 0.5–3 years). No patients were lost to followup.

Results

Preoperative International Knee Documentation Committee subjective outcome scores averaged 43.5 (range, 14–66) and final postoperative values averaged 76.2 (range, 54–88). Preoperative valgus stress radiographs averaged 6.2 mm of medial compartment gapping compared with the contralateral normal knee, whereas postoperative stress radiographs averaged 1.3 mm.

Conclusions

Early observations suggest this anatomic reconstruction technique improves overall patient function and restores valgus instability.
Appendix
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Literature
1.
go back to reference Agel J, LaPrade RF. Assessment of differences between the Modified Cincinnati and International Knee Documentation Committee Patient outcome scores: a prospective study. Am J Sports Med. 2009;37:2151–2157.PubMedCrossRef Agel J, LaPrade RF. Assessment of differences between the Modified Cincinnati and International Knee Documentation Committee Patient outcome scores: a prospective study. Am J Sports Med. 2009;37:2151–2157.PubMedCrossRef
2.
go back to reference 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 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
3.
go back to reference Coobs BR, Wijdicks CA, Armitage BM, Spiridonov SI, Westerhaus BD, Johansen S, Engebretsen L, LaPrade RF. An in vitro analysis of an anatomic medial knee reconstruction. Am J Sports Med. 2010;38:339–347.PubMedCrossRef Coobs BR, Wijdicks CA, Armitage BM, Spiridonov SI, Westerhaus BD, Johansen S, Engebretsen L, LaPrade RF. An in vitro analysis of an anatomic medial knee reconstruction. Am J Sports Med. 2010;38:339–347.PubMedCrossRef
4.
go back to reference Griffith CJ, LaPrade RF, Johansen S, Armitage B, Wijdicks C, Engebretsen L. Medial knee injury. Part 1. Static function of the individual components of the main medial knee structures. Am J Sports Med. 2009;37:1762–1770.PubMedCrossRef Griffith CJ, LaPrade RF, Johansen S, Armitage B, Wijdicks C, Engebretsen L. Medial knee injury. Part 1. Static function of the individual components of the main medial knee structures. Am J Sports Med. 2009;37:1762–1770.PubMedCrossRef
5.
go back to reference Griffith CJ, Wijdicks CA, LaPrade RF, Armitage BM, Johansen S, Engebretsen L. Force measurements on the posterior oblique ligament and superficial medial collateral ligament proximal and distal divisions to applied loads. Am J Sports Med. 2009;37:140–148.PubMedCrossRef Griffith CJ, Wijdicks CA, LaPrade RF, Armitage BM, Johansen S, Engebretsen L. Force measurements on the posterior oblique ligament and superficial medial collateral ligament proximal and distal divisions to applied loads. Am J Sports Med. 2009;37:140–148.PubMedCrossRef
6.
go back to reference Hefti F, Muller W, Jakob RP, Stabubli HU. Evaluation of knee ligament injuries with the IKDC form. Knee Surg Sports Traumatol Arthrosc. 1993;1:226.PubMedCrossRef Hefti F, Muller W, Jakob RP, Stabubli HU. Evaluation of knee ligament injuries with the IKDC form. Knee Surg Sports Traumatol Arthrosc. 1993;1:226.PubMedCrossRef
7.
go back to reference 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;90:1323–1327.PubMedCrossRef 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;90:1323–1327.PubMedCrossRef
8.
go back to reference 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;38:330–338.PubMedCrossRef 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;38:330–338.PubMedCrossRef
9.
go back to reference LaPrade 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;89:2000–2010.PubMedCrossRef LaPrade 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;89:2000–2010.PubMedCrossRef
10.
go back to reference 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;37:1116–1122.PubMedCrossRef 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;37:1116–1122.PubMedCrossRef
11.
go back to reference Miyamoto RG, Bosco JA, Sherman OH. Treatment of medial collateral ligament injuries. J Am Acad Orthop Surg. 2009;17:152–161.PubMed Miyamoto RG, Bosco JA, Sherman OH. Treatment of medial collateral ligament injuries. J Am Acad Orthop Surg. 2009;17:152–161.PubMed
12.
go back to reference Wijdicks CA, Brand EJ, Nuckley DJ, Johansen S, LaPrade RF, Engebretsen L. Biomechanical evaluation of a medial knee reconstruction with comparison of bioabsorbable interference screw constructs and optimization with a cortical button. Knee Surg Sports Traumatol Arthrosc. 2010;18:1532–1541.PubMedCrossRef Wijdicks CA, Brand EJ, Nuckley DJ, Johansen S, LaPrade RF, Engebretsen L. Biomechanical evaluation of a medial knee reconstruction with comparison of bioabsorbable interference screw constructs and optimization with a cortical button. Knee Surg Sports Traumatol Arthrosc. 2010;18:1532–1541.PubMedCrossRef
13.
go back to reference 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;92:1266–1280.PubMedCrossRef 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;92:1266–1280.PubMedCrossRef
14.
go back to reference Wijdicks CA, Griffith CJ, LaPrade RF, Johansen S, Sunderland A, Arendt EA, Engebretsen L. Radiographic identification of the primary medial knee structures. J Bone Joint Surg Am. 2009;91:521–529.PubMedCrossRef Wijdicks CA, Griffith CJ, LaPrade RF, Johansen S, Sunderland A, Arendt EA, Engebretsen L. Radiographic identification of the primary medial knee structures. J Bone Joint Surg Am. 2009;91:521–529.PubMedCrossRef
15.
go back to reference Wijdicks CA, Griffith CJ, LaPrade RF, Spiridonov SI, Johansen S, Armitage BM, Engebretsen L. Medial knee injury. Part 2. Load sharing between the posterior oblique ligament and superficial medial collateral ligament. Am J Sports Med. 2009;37:1771–1776.PubMedCrossRef Wijdicks CA, Griffith CJ, LaPrade RF, Spiridonov SI, Johansen S, Armitage BM, Engebretsen L. Medial knee injury. Part 2. Load sharing between the posterior oblique ligament and superficial medial collateral ligament. Am J Sports Med. 2009;37:1771–1776.PubMedCrossRef
Metadata
Title
Surgical Technique: Development of an Anatomic Medial Knee Reconstruction
Authors
Robert F. LaPrade, MD, PhD
Coen A. Wijdicks, PhD
Publication date
01-03-2012
Publisher
Springer-Verlag
Published in
Clinical Orthopaedics and Related Research® / Issue 3/2012
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI
https://doi.org/10.1007/s11999-011-2061-1

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