Advertisement

Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 23, Issue 10, pp 2797–2804 | Cite as

Anteromedial rotatory laxity

  • Lars Engebretsen
  • Martin LindEmail author
Knee

Abstract

This paper describes anteromedial rotatory laxity of the knee joint. Combined instability of the superficial MCL and the structures of the posteromedial corner is the pathological background anteromedial rotatory laxity. Anteromedial rotatory instability is clinically characterized by anteromedial tibial plateau subluxation anterior to the corresponding femoral condyle. The anatomical and biomechanical background for anteromedial laxity is presented and related to the clinical evaluation, and treatment decision strategies are mentioned. A review of the clinical studies that address surgical treatment of anteromedial rotatory instability including surgical techniques and clinical outcomes is presented.

Level of evidence V.

Keywords

Medial collateral ligament Posterior oblique ligament Anteromedial rotatory instability Anatomical ligament reconstruction 

References

  1. 1.
    Borden PS, Kantaras AT, Caborn DN (2002) Medial collateral ligament reconstruction with allograft using a double-bundle technique. Arthroscopy 18(4):E19CrossRefPubMedGoogle Scholar
  2. 2.
    Bosworth DM (1952) Transplantation of the semitendinosus for repair of laceration of medial collateral ligament of the knee. J Bone LaPrade Surg Am 34-A(1):196–202Google Scholar
  3. 3.
    Coobs BR, LaPrade RF, Griffith CJ, Nelson BJ (2007) Biomechanical analysis of an isolated fibular (lateral) collateral ligament reconstruction using an autogenous semitendinosus graft. Am J Sports Med 35(9):1521–1527CrossRefPubMedGoogle Scholar
  4. 4.
    Coobs BR, Wijdicks CA, Armitage BM, Spiridonov SI, Westerhaus BD, Johansen S, Engebretsen L, LaPrade RF (2010) An in vitro analysis of an anatomical medial knee reconstruction. Am J Sports Med 38(2):339–347CrossRefPubMedGoogle Scholar
  5. 5.
    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(6):1185–1190PubMedGoogle Scholar
  6. 6.
    Giannotti BF, Fanelli GC, Barrett TA, Edson C (1996) The predictive value of intraoperative KT-1000 arthrometer measurements in single incision anterior cruciate ligament reconstruction. Arthroscopy 12(6):660–666CrossRefPubMedGoogle Scholar
  7. 7.
    Gorin S, Paul DD, Wilkinson EJ (2003) An anterior cruciate ligament and medial collateral ligament tear in a skeletally immature patient: a new technique to augment primary repair of the medial collateral ligament and an allograft reconstruction of the anterior cruciate ligament. Arthroscopy 19(10):E21–E26CrossRefPubMedGoogle Scholar
  8. 8.
    Grana WA, Gimple K (1981) Reconstruction of traumatic complete loss of the medial collateral ligament: a case report. Clin Orthop Relat Res 160:153–157PubMedGoogle Scholar
  9. 9.
    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):1762–1770CrossRefPubMedGoogle Scholar
  10. 10.
    Griffith CJ, Wijdicks CA, LaPrade RF, Armitage BM, Johansen S, Engebretsen L (2009) Force measurements on the posterior oblique ligament and superficial medial collateral ligament proximal and distal divisions to applied loads. Am J Sports Med 37(1):140–148CrossRefPubMedGoogle Scholar
  11. 11.
    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(8):1257–1269PubMedGoogle Scholar
  12. 12.
    Hughston JC (1962) Acute knee injuries in athletes. Clin Orthop 23:114–133PubMedGoogle Scholar
  13. 13.
    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(9):1328–1344PubMedGoogle Scholar
  14. 14.
    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(5):923–940PubMedGoogle Scholar
  15. 15.
    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 256:174–177PubMedGoogle Scholar
  16. 16.
    Jacobson KE, Chi FS (2006) Evaluation and treatment of medial collateral ligament and medial-sided injuries of the knee. Sports Med Arthrosc 14(2):58–66CrossRefPubMedGoogle Scholar
  17. 17.
    Kannus P (1988) Long-term results of conservatively treated medial collateral ligament injuries of the knee joint. Clin Orthop Relat Res 226:103–112PubMedGoogle Scholar
  18. 18.
    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(2):330–338CrossRefPubMedGoogle Scholar
  19. 19.
    LaPrade RF, Engebretsen AH, Ly TV, Johansen S, Wentorf FA, Engebretsen L (2007) The anatomy of the medial part of the knee. J Bone Joint Surg Am 89(9):2000–2010CrossRefPubMedGoogle Scholar
  20. 20.
    Laprade RF, Wijdicks CA (2012) The management of injuries to the medial side of the knee. J Orthop Sports Phys Ther 42(3):221–233CrossRefPubMedGoogle Scholar
  21. 21.
    LaPrade RF, Wijdicks CA (2012) Surgical technique: development of an anatomic medial knee reconstruction. Clin Orthop Relat Res 470(3):806–814PubMedCentralCrossRefPubMedGoogle Scholar
  22. 22.
    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):1116–1122CrossRefPubMedGoogle Scholar
  23. 23.
    Lubowitz JH, Bernardini BJ, Reid JB 3rd (2008) Current concepts review: comprehensive physical examination for instability of the knee. Am J Sports Med 36(3):577–594CrossRefPubMedGoogle Scholar
  24. 24.
    Marchant MH Jr, Tibor LM, Sekiya JK, Hardaker WT Jr, Garrett WE Jr, Taylor DC (2011) Management of medial-sided knee injuries, part 1: medial collateral ligament. Am J Sports Med 39(5):1102–1113CrossRefPubMedGoogle Scholar
  25. 25.
    Marx RG, Hetsroni I (2012) Surgical technique: medial collateral ligament reconstruction using Achilles allograft for combined knee ligament injury. Clin Orthop Relat Res 470(3):798–805PubMedCentralCrossRefPubMedGoogle Scholar
  26. 26.
    O’Donoghue DH (1973) Reconstruction for medial instability of the knee. J Bone Joint Surg Am 55(5):941–954PubMedGoogle Scholar
  27. 27.
    Petersen W, Loerch S, Schanz S, Raschke M, Zantop T (2008) The role of the posterior oblique ligament in controlling posterior tibial translation in the posterior cruciate ligament-deficient knee. Am J Sports Med 36(3):495–501CrossRefPubMedGoogle Scholar
  28. 28.
    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):1815–1823CrossRefPubMedGoogle Scholar
  29. 29.
    Sims WF, Jacobson KE (2004) The posteromedial corner of the knee: medial-sided injury patterns revisited. Am J Sports Med 32(2):337–345CrossRefPubMedGoogle Scholar
  30. 30.
    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(2):226–242PubMedGoogle Scholar
  31. 31.
    Slocum DB, Larson RL (1968) Rotatory instability of the knee. Its pathogenesis and a clinical test to demonstrate its presence. J Bone Joint Surg Am 50(2):211–225PubMedGoogle Scholar
  32. 32.
    Slocum DB, Larson RL (2007) Rotatory instability of the knee: its pathogenesis and a clinical test to demonstrate its presence. 1968. Clin Orthop Relat Res 454:5–13 (discussion 13–14) CrossRefPubMedGoogle Scholar
  33. 33.
    Tibor LM, Marchant MH Jr, Taylor DC, Hardaker WT Jr, Garrett WE Jr, Sekiya JK (2011) Management of medial-sided knee injuries, part 2: posteromedial corner. Am J Sports Med 39(6):1332–1340CrossRefPubMedGoogle Scholar
  34. 34.
    Torg JS, Conrad W, Kalen V (1976) Clinical diagnosis of anterior cruciate ligament instability in the athlete. Am J Sports Med 4(2):84–93CrossRefPubMedGoogle Scholar
  35. 35.
    Warren LA, Marshall JL, Girgis F (1974) The prime static stabilizer of the medical side of the knee. J Bone Joint Surg Am 56(4):665–674PubMedGoogle Scholar
  36. 36.
    Wijdicks CA, Ewart DT, Nuckley DJ, Johansen S, Engebretsen L, LaPrade RF (2010) Structural properties of the primary medial knee ligaments. Am J Sports Med 38(8):1638–1646CrossRefPubMedGoogle Scholar
  37. 37.
    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 Joint Surg Am 92(5):1266–1280CrossRefPubMedGoogle Scholar
  38. 38.
    Yoshiya S, Kuroda R, Mizuno K, Yamamoto T, Kurosaka M (2005) Medial collateral ligament reconstruction using autogenous hamstring tendons: technique and results in initial cases. Am J Sports Med 33(9):1380–1385CrossRefPubMedGoogle Scholar

Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2015

Authors and Affiliations

  1. 1.Department of Orthopaedic SurgeryOslo University HospitalOsloNorway
  2. 2.Faculty of MedicineUniversity of OsloOsloNorway
  3. 3.Oslo Sports Trauma Research CenterNorwegian School of Sport SciencesOsloNorway
  4. 4.Division of Sports Trauma, Orthopedic DepartmentAarhus University HospitalAarhus CDenmark

Personalised recommendations