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Medial Collateral Ligament Reconstruction With Anteromedial Reinforcement for Medial and Anteromedial Rotatory Instability of the Knee.

ABSTRACT: Even though structures of the medial side of the knee have a high potential to heal without surgery, in some circumstances injuries of this region may lead to development of chronic medial and anteromedial rotatory instability (AMRI). In those circumstances, surgery should be performed. Current-day surgical techniques are focused on recreating the function of the main stabilizers of the medial side of the knee, which are the medial collateral ligament and the posterior oblique ligament, but they omit the role of the anteromedial capsule. Nonetheless, they are able to restore at most "near-native" biomechanics of the joint, are highly invasive, and require advanced skills in posteromedial knee surgery. Maybe we should take a look at chronic medial instability and AMRI from the other side? We present a minimally invasive reconstruction of the superficial medial collateral ligament with anteromedial reinforcement for the AMRI component. Level of evidence: 1 (knee) and 2 (collateral ligaments).

SUBMITTER: Malinowski K

PROVIDER: S-EPMC6823834 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:PurposeTo quantify intraoperative joint space widening afforded by the outside-in, percutaneous release of the medial collateral ligament (MCL) and to evaluate its impact on medial compartment width and functional outcomes at 6-week follow-up for patients undergoing a partial medial meniscectomy without postoperative bracing.MethodsPatients with posteromedial meniscus tears and no evidence of ipsilateral knee pathology, undergoing partial medial meniscectomy, were enrolled. Intraoperatively, medial compartment width was quantified with fluoroscopy before and after the percutaneous MCL release with an 18-gauge spinal needle proximal to the joint line. At 6-week follow-up, valgus stress radiographs re-evaluated medial compartment width. International Knee Documentation Committee (IKDC) and Patient-Reported Outcomes Measurement Information System (PROMIS) scores were completed preoperatively and at 6-week follow-up to evaluate functional outcomes. A paired sample t test performed at a 95% confidence interval (CI) was used to compare these variables.ResultsForty-two patients, mean (± standard deviation) age 55.3 ± 10.7 years, were available for analysis of intraoperative medial compartment widening. Medial compartment width increased from 5.95 ± 1.32 to 11.09 ± 1.74 mm intraoperatively after MCL release. At 6-week follow-up, radiographic assessment demonstrated a mean medial compartment width of 5.85 ± .99 mm, which represented an insignificant change compared with the preoperative value (CI -0.68 to .33, P = .474). PROMIS and IKDC scores significantly improved from baseline, with increases of 6.9 ± 12.4 (CI 2.0 to 11.8, P = .008) and 11.7 ± 17.8 (CI 4.7 to 18.8, P = .002), respectively.ConclusionsPercutaneous MCL release during knee arthroscopy improves visualization and facilitates instrumentation by providing an almost 2× wider working space within the medial tibiofemoral joint. In this study, the performance of percutaneous MCL release did not result in any complications. Radiographic and clinical resolution of iatrogenic laxity was demonstrated by 6-weeks postoperatively, without the use of postoperative bracing.Level of evidenceIV, therapeutic case series.

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Medial Collateral Ligament Reconstruction With Anteromedial Reinforcement for Medial and Anteromedial Rotatory Instability of the Knee.

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