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A comparative biomechanical study of alternative medial collateral ligament reconstruction techniques
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shatrov-et-al-2024-a-comparative-biomechanical-study-of-alternative-medial-collateral-ligament-reconstruction-techniques.pdf | Published version | 1.48 MB | Adobe PDF | View/Open |
Title: | A comparative biomechanical study of alternative medial collateral ligament reconstruction techniques |
Authors: | Shatrov, J Bonacic Bartolin, P Holthof, SR Ball, S Williams, A Amis, AA |
Item Type: | Journal Article |
Abstract: | BACKGROUND: There is little evidence of the biomechanical performance of medial collateral ligament (MCL) reconstructions for restoring stability to the MCL-deficient knee regarding valgus, external rotation (ER), and anteromedial rotatory instability (AMRI). HYPOTHESIS: A short isometric reconstruction will better restore stability than a longer superficial MCL (sMCL) reconstruction, and an additional deep MCL (dMCL) graft will better control ER and AMRI than single-strand reconstructions. STUDY DESIGN: Controlled laboratory study. METHODS: Nine cadaveric human knees were tested in a kinematics rig that allowed tibial loading while the knee was flexed-extended 0° to 100°. Optical markers were placed on the femur and tibia and displacements were measured using a stereo camera system. The knee was tested intact, and then after MCL (sMCL + dMCL) transection, and loaded in anterior tibial translation (ATT), ER, varus-valgus, and combined ATT + ER (AMRI loading). Five different isometric MCL reconstructions were tested: isolated long sMCL, a short construct, each with and without dMCL addition, and isolated dMCL reconstruction, using an 8 mm-wide synthetic graft. RESULTS: MCL deficiency caused an increase in ER of 4° at 0° of flexion (P = .271) up to 14° at 100° of flexion (P = .002), and valgus laxity increased by 5° to 8° between 0° and 100° of flexion (P < .024 at 0°-90°). ATT did not increase significantly in isolated MCL deficiency (P > .999). All 5 reconstructions restored native stability across the arc of flexion apart from the isolated long sMCL, which demonstrated residual ER instability (P≤ .047 vs other reconstructions). CONCLUSION: All tested techniques apart from the isolated long sMCL graft are satisfactory in the context of restoring the valgus, ER, and AMRI stability to the MCL-deficient knee in a cadaveric model. CLINICAL RELEVANCE: Contemporary MCL reconstruction techniques fail to control ER and therefore AMRI as they use a long sMCL graft and do not address the dMCL. This study compares 5 MCL reconstruction techniques. Both long and short isometric constructs other than the long sMCL achieved native stability in valgus and ER/AMRI. Double-strand reconstructions (sMCL + dMCL) tended to provide more stability. This study shows which reconstructions demonstrate the best biomechanical performance, informs surgical reconstruction techniques for AMRI, and questions the efficacy of current popular techniques. |
Issue Date: | May-2024 |
Date of Acceptance: | 3-Jan-2024 |
URI: | http://hdl.handle.net/10044/1/111680 |
DOI: | 10.1177/03635465241235858 |
ISSN: | 0363-5465 |
Publisher: | SAGE Publications |
Start Page: | 1505 |
End Page: | 1513 |
Journal / Book Title: | American Journal of Sports Medicine |
Volume: | 52 |
Issue: | 6 |
Copyright Statement: | © 2024 The Author(s). Creative Commons License (CC BY 4.0) This article is distributed under the terms of the Creative Commons Attribution 4.0 License (https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). |
Publication Status: | Published |
Conference Place: | United States |
Online Publication Date: | 2024-03-29 |
Appears in Collections: | Mechanical Engineering |
This item is licensed under a Creative Commons License