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The medial ligaments and the ACL restrain anteromedial laxity of the knee

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Title: The medial ligaments and the ACL restrain anteromedial laxity of the knee
Authors: Ball, S
Stephen, JM
El-Daou, H
Williams, A
Amis, AA
Item Type: Journal Article
Abstract: Purpose The purpose of this study was to determine the contribution of each of the ACL and medial ligament structures in resisting anteromedial rotatory instability (AMRI) loads applied in vitro. Methods Twelve knees were tested using a robotic system. It imposed loads simulating clinical laxity tests at 0° to 90° flexion: ±90 N anterior–posterior force, ±8 Nm varus–valgus moment, and ±5 Nm internal–external rotation, and the tibial displacements were measured in the intact knee. The ACL and individual medial structures—retinaculum, superficial and deep medial collateral ligament (sMCL and dMCL), and posteromedial capsule with oblique ligament (POL + PMC)—were sectioned sequentially. The tibial displacements were reapplied after each cut and the reduced loads required allowed the contribution of each structure to be calculated. Results For anterior translation, the ACL was the primary restraint, resisting 63–77% of the drawer force across 0° to 90°, the sMCL contributing 4–7%. For posterior translation, the POL + PMC contributed 10% of the restraint in extension; other structures were not significant. For valgus load, the sMCL was the primary restraint (40–54%) across 0° to 90°, the dMCL 12%, and POL + PMC 16% in extension. For external rotation, the dMCL resisted 23–13% across 0° to 90°, the sMCL 13–22%, and the ACL 6–9%. Conclusion The dMCL is the largest medial restraint to tibial external rotation in extension. Therefore, following a combined ACL + MCL injury, AMRI may persist if there is inadequate healing of both the sMCL and dMCL, and MCL deficiency increases the risk of ACL graft failure.
Issue Date: Dec-2020
Date of Acceptance: 28-May-2020
URI: http://hdl.handle.net/10044/1/82821
DOI: 10.1007/s00167-020-06084-4
ISSN: 0942-2056
Publisher: Springer
Start Page: 3700
End Page: 3708
Journal / Book Title: Knee Surgery Sports Traumatology Arthroscopy
Volume: 28
Copyright Statement: © The Author(s) 2020. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
Keywords: Science & Technology
Life Sciences & Biomedicine
Orthopedics
Sport Sciences
Surgery
Anteromedial rotatory instability
Anterior cruciate ligament
Medial collateral ligament
Posterior oblique ligament
Biomechanics
Restraint of tibiofemoral joint laxity
ANTERIOR CRUCIATE LIGAMENT
COLLATERAL LIGAMENT
ANTEROLATERAL LIGAMENT
FOLLOW-UP
RECONSTRUCTION
INTACT
FORCE
TEARS
INSTABILITY
ANATOMY
Anterior cruciate ligament
Anteromedial rotatory instability
Biomechanics
Medial collateral ligament
Posterior oblique ligament
Restraint of tibiofemoral joint laxity
Science & Technology
Life Sciences & Biomedicine
Orthopedics
Sport Sciences
Surgery
Anteromedial rotatory instability
Anterior cruciate ligament
Medial collateral ligament
Posterior oblique ligament
Biomechanics
Restraint of tibiofemoral joint laxity
ANTERIOR CRUCIATE LIGAMENT
COLLATERAL LIGAMENT
ANTEROLATERAL LIGAMENT
FOLLOW-UP
RECONSTRUCTION
INTACT
FORCE
TEARS
INSTABILITY
ANATOMY
Orthopedics
1103 Clinical Sciences
1106 Human Movement and Sports Sciences
Publication Status: Published
Online Publication Date: 2020-06-05
Appears in Collections:Faculty of Engineering
Mechanical Engineering



This item is licensed under a Creative Commons License Creative Commons