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Suture tape augmentation improves laxity of MCL repair in the ACL reconstructed knee

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  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Medial collateral ligament (MCL) injury is very common and surgical repair is sometimes necessary. Especially in the setting of simultaneous anterior cruciate ligament reconstruction (ACLR) as the ACL is the secondary restraint against valgus stress. The goal of this study was to evaluate knee biomechanics after suture repair of the MCL augmented with suture tape, as compared to MCL repair alone, in the setting of concomitant ACL reconstruction (ACLR).

Methods

Fifteen fresh-frozen human cadaveric knees were tested using a six-degrees-of-freedom robotic system under four loadings: (a) an 89.0 N anterior tibial load, (b) a 5.0 Nm internal and external rotation torque, (c) a 10.0 Nm valgus load, (d) a 7.0 Nm valgus load combined with 5.0 Nm internal rotation torque as a static simulated pivot-shift. The tested conditions were ACLR with the following states: (1) MCL intact, (2) MCL deficient, (3) MCL Repair, and (4) MCL repair augmented with suture tape (MCL Repair + ST). Under the different knee loadings, the tibial displacement, and the force in either the intact MCL, suture repaired MCL or repaired MCL-suture tape complex was measured.

Results

While neither the MCL Repair nor the MCL Repair + ST restored valgus rotation to the MCL intact state, displacement was significantly smaller after MCL Repair + ST (p < 0.05). The knee rotation under external rotation torque in MCL Repair + ST did not differ MCL intact (n.s.), while with MCL Repair the rotation was significantly greater (p < 0.05). MCL Repair + ST did not cause an over-constraint of the knee in any of the tested loading conditions.

Conclusion

In a combined ACL-reconstruction-MCL-repair model, MCL Repair augmented with suture tape improved valgus and external rotation laxity when compared to MCL suture repair alone. Suture tape augmentation may provide this additional means of stabilization and can be added at the time of surgical repair of the MCL. Clinically this may result in lower failure rates and less residual laxity after MCL repair, as well as shorter immobilization times and faster return to play.

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Authors and Affiliations

  1. Orthopaedic Engineering and Sports Medicine Laboratory, University of Pittsburgh, Pittsburgh, PA, USA

    Carola F. van Eck, Tomomasa Nakamura, Taylor Price, Monica Linde & Patrick Smolinski

  2. Department of Orthopaedic Surgery, Freddie Fu Sports Complex, University of Pittsburgh, 3200 South Water Street, Pittsburgh, PA, USA

    Carola F. van Eck

  3. Department of Joint Surgery and Sports Medicine, Tokyo Medical and Dental University, Tokyo, Japan

    Tomomasa Nakamura

Authors
  1. Carola F. van Eck
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  2. Tomomasa Nakamura
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  3. Taylor Price
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  4. Monica Linde
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  5. Patrick Smolinski
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Contributions

The author states that this manuscript is an original work only submitted to this journal. All authors contributed to the preparation of this work.

Corresponding author

Correspondence to Carola F. van Eck.

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The author(s) declare that they have no competing interests.

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The author did not receive any outside funding or grants directly related to the research presented in this manuscript.

Ethical approval

The implants used to perform the MCL repair and suture tape augmentation were provided by Arthrex through a Materials Transfer Agreement with the University of Pittsburgh.

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van Eck, C.F., Nakamura, T., Price, T. et al. Suture tape augmentation improves laxity of MCL repair in the ACL reconstructed knee. Knee Surg Sports Traumatol Arthrosc 29, 2545–2552 (2021). https://doi.org/10.1007/s00167-020-06386-7

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  • DOI: https://doi.org/10.1007/s00167-020-06386-7

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