Abstract
Purpose
The purpose of this study was to evaluate and compare the resulting knee kinematics and stability of an anatomic superficial MCL (sMCL) reconstruction and a non-anatomic sMCL reconstruction.
Methods
In a cadaveric model, normal knee stability and kinematics were compared with sMCL deficient knees and with two experimental sMCL reconstructions. The first reconstruction (AnatRecon) attempted to anatomically reconstruct the sMCL. The second reconstruction (ShortRecon) used a shorter graft to mimic the effect of failing to reproduce the anatomic length of the sMCL. Changes in position of the femur with respect to the tibia were measured with an electromagnetic tracking system during simulated active knee extension and during passive knee stability testing in the sMCL intact knee, the sMCL deficient knee, and the two experimental reconstructions.
Results
Simulated active knee extension demonstrated a significant increase in external tibial rotation of ShortRecon compared to AnatRecon between 30° and 80° of knee flexion (mean difference <3.0° over the range of knee flexion angles; P < 0.008), and a significant increase in external tibial rotation of ShortRecon compared to the intact sMCL was found at 60° and 70° of knee flexion (mean difference <2.0°over the range of knee flexion angles; P < 0.008). Passive joint stability testing demonstrated that division of the sMCL produced approximately 6° of valgus laxity at 30° of knee flexion and increased external tibial rotation of approximately 5° at 30°, 9° at 60°, and 10° at 90° of knee flexion, respectively. AnatRecon restored normal knee kinematics and stability. Additionally, passive stability testing demonstrated a significant increase in external tibial rotation of ShortRecon compared to AnatRecon at 60° (mean difference = 3.7°; P < 0.05) and 90° of knee flexion (mean difference = 4.9°; P < 0.05).
Conclusion
Anatomic reconstruction of the sMCL effectively restored knee kinematics and stability in the sMCL deficient knee. Altering the normal ligament length resulted in measurable changes in knee kinematics and stability. This study suggests that in cases of chronic valgus knee instability, anatomic sMCL reconstruction would provide better results than non-anatomic sMCL reconstruction.
Similar content being viewed by others
References
Ballmer PM, Jakob RP (1988) The non operative treatment of isolated complete tears of the medial collateral ligament of the knee. A prospective study. Arch Orthop Trauma Surg 107:273–276
Borden PS, Kantaras AT, Caborn DN (2002) Medial collateral ligament reconstruction with allograft using a double-bundle technique. Arthroscopy 18:E19
Bosworth DM (1952) Transplantation of the semitendinosus for repair of laceration of medial collateral ligament of the knee. J Bone Joint Surg Am 34:196–202
Coobs BR, Widjicks CA, Armitage BM et al (2010) An in vitro analysis of an anatomical medial knee reconstruction. Am J Sports Med 38:339–347
Ellsasser JC, Reynolds FC, Omohundro JR (1974) The non-operative treatment of collateral ligament injuries of the knee in professional football players. An analysis of seventy-four injuries treated non-operatively and twenty-four injuries treated surgically. J Bone Joint Surg Am 56:1185–1190
Feeley BT, Muller MS, Allen AA et al (2009) Biomechanical comparison of medial collateral ligament reconstructions using computer-assisted navigation. Am J Sports Med 37:1123–1130
Griffith CJ, LaPrade RF, Johansen S et al (2009) Medial knee injury: part 1, static function of the individual components of the main medial knee structures. Am J Sports Med 37:1762–1770
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 Joint Surg Am 63:1257–1269
Haimes JL, Wroble RR, Grood ES, Noyes FR (1994) Role of the medial structures in the intact and anterior cruciate ligament-deficient knee. Limits of motion in the human knee. Am J Sports Med 22:402–409
Hillard-Sembell D, Daniel DM, Stone ML et al (1996) Combined injuries of the anterior cruciate and medial collateral ligaments of the knee. Effect of treatment on stability and function of the joint. J Bone Joint Surg Am 78:169–176
Hughston JC (1994) The importance of the posterior oblique ligament in repairs of acute tears of the medial ligaments in knees with and without an associated rupture of the anterior cruciate ligament. Results of long-term follow-up. J Bone Joint Surg Am 76:1328–1344
Hughston JC, Eilers AF (1973) The role of the posterior oblique ligament in repairs of acute medial (collateral) ligament tears of the knee. J Bone Joint Surg Am 55:923–940
Indelicato PA (1983) Non-operative treatment of complete tears of the medial collateral ligament of the knee. J Bone Joint Surg Am 65:323–329
Indelicato PA, Hermansdorfer J, Huegel M (1990) Nonoperative management of complete tears of the medial collateral ligament of the knee in intercollegiate football players. Clin Orthop Relat Res 256:174–177
Kannus P (1988) Long-term results of conservatively treated medial collateral ligament injuries of the knee joint. Clin Orthop Relat Res 226:103–112
Kim SJ, Choi NH, Shin SJ (2001) Semitendinosus tenodesis for medial instability of the knee. Arthroscopy 17:660–663
Milne AD, Chess DG, Johnson JA, King GJ (1996) Accuracy of an electromagnetic tracking device: a study of the optimal range and metal interference. J Biomech 29:791–793
Nicholas JA (1973) The five-one reconstruction for anteromedial instability of the knee. Indications, technique, and the results in fifty-two patients. J Bone Joint Surg Am 55:899–922
Noyes FR, Barber-Westin SD (1995) The treatment of acute combined ruptures of the anterior cruciate and medial ligaments of the knee. Am J Sports Med 23:380–389
O’Donoghue DH (1973) Reconstruction for medial instability of the knee. J Bone Joint Surg Am 55:941–954
Reider B, Sathy MR, Talkington J et al (1994) Treatment of isolated medial collateral ligament injuries in athletes with early functional rehabilitation. A 5-year follow-up study. Am J Sports Med 22:470–477
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 34:1815–1823
Sharkey NA, Smith TS, Lundmark DC (1995) Freeze clamping musculo-tendinous junctions for in vitro simulation of joint mechanics. J Biomech 28:631–635
Slocum DB, Larson RL (1968) Pes anserinus transplantation. A surgical procedure for control of rotatory instability of the knee. J Bone Joint Surg Am 50:226–242
Warren LF, Marshall JL (1979) The supporting structures and layers on the medial side of the knee: an anatomical analysis. J Bone Joint Surg Am 61:56–62
Warren LF, Marshall JL, Girgis F (1974) The prime static stabilizer of the medical side of the knee. J Bone Joint Surg Am 56:665–674
Wijdicks CA, Griffith CJ, LaPrade RF et al (2009) Medial knee injury: part 2, load sharing between the posterior oblique ligament and superficial medial collateral ligament. Am J Sports Med 37:1771–1776
Wijdicks CA, Griffith CJ, Johansen S et al (2010) Injuries to the medial collateral ligament and associated medial structures of the knee. J Bone Joint Surg Am 92:1266–1280
Wijdicks CA, Ewart DT, Nuckley DJ et al (2010) Structural properties of the primary medial knee ligaments. Am J Sports Med 38:1638–1646
Yoshiya S, Kuroda R, Mizuno K et al (2005) Medial collateral ligament reconstruction using autogenous hamstring tendons: technique and results in initial cases. Am J Sports Med 33:1380–1385
Conflict of interest
The authors declare that they have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Van den Bogaerde, J.M., Shin, E., Neu, C.P. et al. The superficial medial collateral ligament reconstruction of the knee: effect of altering graft length on knee kinematics and stability. Knee Surg Sports Traumatol Arthrosc 19 (Suppl 1), 60–68 (2011). https://doi.org/10.1007/s00167-011-1519-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00167-011-1519-8