Accidental Falls ; statistics & numerical data ; Accidents, Traffic ; statistics & numerical data ; Adult ; Age Distribution ; Anterior Cruciate Ligament Injuries ; epidemiology ; surgery ; Athletic Injuries ; epidemiology ; Female ; Humans ; Knee Injuries ; epidemiology ; surgery ; Male ; Medial Collateral Ligament, Knee ; injuries ; surgery ; Middle Aged ; Motorcycles ; Orthopedics ; Pedestrians ; Posterior Cruciate Ligament ; injuries ; surgery ; Reconstructive Surgical Procedures ; Retrospective Studies ; Sex Distribution ; Singapore ; epidemiology ; Trauma Centers ; Young Adult

BACKGROUND: During ligament balancing for severe medial contracture in varus knee total knee arthroplasty (TKA), complete distal release of the medial collateral ligament (MCL) or a medial epicondylar osteotomy can be necessary if a large amount of correction is needed. METHODS: This study retrospectively reviewed 9 cases of complete distal release of the MCL and 11 cases of medial epicondylar osteotomy which were used to correct severe medial contracture. The mean follow-up periods were 46.5 months (range, 36 to 78 months) and 39.8 months (range, 32 to 65 months), respectively. RESULTS: There were no significant differences in the clinical results between the two groups. However, the valgus stress radiograph revealed significant differences in medial instability. In complete distal release of the MCL, some stability was obtained by repair and bracing but the medial instability could not be removed completely. CONCLUSIONS: Medial epicondylar osteotomy for a varus deformity in TKA could provide constant medial stability and be a useful ligament balancing technique.
Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Knee/*methods ; Female ; Humans ; Knee Joint/physiopathology/radiography/*surgery ; Ligaments ; Ligaments, Articular/*physiopathology ; Medial Collateral Ligament, Knee/physiopathology/*surgery ; Middle Aged ; Osteotomy/*methods ; Retrospective Studies ; Treatment Outcome

OBJECTIVETo discuss a new technique about reconstruction of medial collateral ligament (MCL) with double bundle allograft and to evaluate the short-term clinical efficacy.

METHODSAll 53 patients who suffered from valgus instability of the knee were selected. All cases were diagnosed of MCL injury because the medial gap of the knee widened more than 5 mm compared with collateral knee by the stress X-ray, MRI displayed discontinuity of MCL and valgus stress test was positive. All patients were accepted arthroscopic evaluation through inferomedial and inferolateral arthroscopy portal incisions to ascertain whether there were intra-articular injuries. An 8 cm incision was made from 1 cm superior adductor tubercle to 5 cm proximal medial tibia joint line in a longitudinal fashion. The anterior tibia insertion was defined as 15 mm lateral from the medial tibia edge and 45 mm under the medial tibia joint line. The posterior tibia insertion was defined as 15 mm lateral from the medial tibia edge and 20 mm under the medial tibia joint line. We used 5 mm or 6 mm reamer to drill the tibia tunnel along with guide pin, and then drill the femur tunnel with 6 mm or 7 mm drill in the top of the adductor tubercle about 25 mm or 30 mm length. The allograft was pulled into the tunnel from tibia to the femur and fixed with absorbable interference screw. Patients carried out active rehabilitation program after operation. One year after the operation, IKDC score, Lysholm score were used to evaluate the clinical effect.

RESULTSThe IKDC score (A or B, 86.78% vs. 0), Lysholm scores (89.7 ± 3.4 vs. 51.8 ± 4.9, t = -79.724, P < 0.05) were significantly improved compared with preoperative in all patients. Medial joint widened gap decreased from (10.4 ± 2.4) mm preoperative to (2.8 ± 1.5) mm postoperative from X ray and the differences were significant (t = 41.727, P < 0.05). Among these patients, the medial joint widened gap of 46 cases were less than 3 mm, 7 cases were from 3 mm to 5 mm. The range of motion was 135.4° ± 2.5° preoperative and 132.7° ± 3.7° postoperative. The 9 patients still had medial tenderness 1 year after operation.

CONCLUSIONApplication double bundle allograft technique to reconstruct MCL can significantly improve the stability of the knee and the short-term clinical efficacy was sure.

Adult ; Female ; Follow-Up Studies ; Humans ; Male ; Medial Collateral Ligament, Knee ; injuries ; surgery ; Middle Aged ; Reconstructive Surgical Procedures ; methods ; Transplantation, Homologous ; Treatment Outcome ; Young Adult

OBJECTIVETo compare the clinical results of single-stranded isometric with double-stranded anatomic reconstruction of medial patellofemoral ligament (MPFL) for recurrent patellar dislocation.

METHODSRetrospective analysis of 60 consecutive patients (72 knees) with recurrent patellar dislocation underwent medial patellofemoral ligament reconstruction between August 2004 and October 2008, 22 cases (27 knees) with single-stranded isometric reconstruction, 38 cases (45 knees) with double-stranded anatomic reconstruction. Postoperatively patellar stability was examined, and recurrent rate was recorded. Patellar lateral shift ratio and tilt were measured on CT scans. Knee function was evaluated with subjective questionnaire and the Kujala score.

RESULTSAll patients were followed up for more than 12 months without recurrent redislocation. (1) Recurrent instability rate was 18.5% in single-stranded group and 2.2% in double-stranded group, with statistical difference (P < 0.05). (2) The patellar tilt and lateral shift ratio returned to normal, without statistical difference between groups (P > 0.05). (3) The Kujala score were 59 ± 9 and 62 ± 9 preoperatively and 87 ± 4 and 94 ± 6 postoperatively in single- and double-stranded group, with statistical difference (P < 0.05). (4) The excellect rate was 85.2% in single-stranded group, 97.8% in double-stranded group, with statistical difference(P < 0.05).

CONCLUSIONBoth reconstruction can improve patellar stability and knee function significantly, with double-stranded anatomic reconstruction better in clinic evaluation.

Adult ; Female ; Follow-Up Studies ; Humans ; Male ; Medial Collateral Ligament, Knee ; surgery ; Patellar Dislocation ; surgery ; Patellar Ligament ; surgery ; Reconstructive Surgical Procedures ; methods ; Retrospective Studies ; Treatment Outcome ; Young Adult

BACKGROUND: This study evaluated the preoperative distractive stress radiographs in order to quantify and predict the extent of medial release according to the degree of varus deformity in primary total knee arthroplasty. METHODS: We evaluated 120 varus, osteoarthritic knee joints (75 patients). The association of the angle on the distractive stress radiograph with extent of medial release was analyzed. The extent of medial release was classified into the following 4 groups according to the stage: release of the deep medial collateral ligament (group 1), release of the posterior oblique ligament and/or semimembranous tendon (group 2), release of the posterior capsule (group 3) and release of the superficial medial collateral ligament (group 4). RESULTS: The mean femorotibial angle on the preoperative distractive stress radiograph was valgus 2.4degrees (group 1), valgus 0.8degrees (group 2), varus 2.1degrees (group 3) and varus 2.7degrees (group 4). The extent of medial release increased with increasing degree of varus deformity seen on the preoperative distractive stress radiograph. CONCLUSIONS: The preoperative distractive stress radiograph was useful for predicting the extent of medial release when performing primary total knee arthroplaty.
Aged ; *Arthroplasty, Replacement, Knee/methods ; Female ; Humans ; Joint Deformities, Acquired/etiology/radiography ; Knee Joint/*radiography ; Ligaments, Articular/radiography ; Male ; Medial Collateral Ligament, Knee/*surgery ; Middle Aged ; Osteoarthritis, Knee/complications/radiography/*surgery

Adult ; Female ; Humans ; Male ; Medial Collateral Ligament, Knee ; injuries ; surgery ; Middle Aged ; Reconstructive Surgical Procedures ; methods

Adolescent ; Adult ; Bone Nails ; Female ; Humans ; Knee Injuries ; surgery ; Male ; Medial Collateral Ligament, Knee ; injuries ; surgery ; Middle Aged

Anterior Cruciate Ligament Injuries ; Humans ; Knee Injuries ; diagnosis ; surgery ; Medial Collateral Ligament, Knee ; injuries ; Posterior Cruciate Ligament ; injuries

Adult ; Female ; Humans ; Male ; Medial Collateral Ligament, Knee ; injuries ; surgery ; Middle Aged ; Reconstructive Surgical Procedures ; methods ; Rupture ; Suture Anchors

OBJECTIVE: To explore surgical reconstruction therapy and clinical effect of serious medial collateral ligament ruptures of the knee. METHODS: Thirty-three patients with medial collateral ligament rupture were treated by operative repair and reconstruction. The degree of injury in all patients was Grade III. Some patients complicated with posterior medial capsule and anterior cruciate ligament, complete posterior cruciate ligament rupture, and some complicated with menisci injury, even tibial plateau fracture. After repairing the anatomical structure of medial collateral ligaments, we liberated organic semitendinous tendon or bone-patella tendon-bone, and reconstructed superficial medial collateral ligament. RESULTS: Thirty-three patients were followed up for 43.1(3 approximately 71) months. After the operation, conditions were improved obviously. Instability and pain of knee released in 27 patients, 5 patients felt pain, and 4 patients still had dysfunction of knee flexion and extension. Stress X-ray showed that: 1 patient's knee joint space widened over 5 mm. According to Lysholm scoring system, the postoperative score was significantly higher than the preoperative score (P<0.01). CONCLUSION Medial collateral ligament reconstruction based on repairing the anatomical structure is effective and satisfactory. Autologous bone-patella tendon-bone or semitendinous tendon is a good choice for medial collateral ligament reconstruction.
Adolescent ; Adult ; Female ; Follow-Up Studies ; Humans ; Male ; Medial Collateral Ligament, Knee ; injuries ; surgery ; Middle Aged ; Patellar Ligament ; transplantation ; Rupture ; surgery ; Tendons ; transplantation ; Transplantation, Autologous ; Young Adult