TIBIAL Inlay RECONSTRUCTION OF MEDIAL COLLATERAL LIGAMENT USING Achilles ALLOGRAFT_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANGHangzhou ¹ ,  BAIXizhuang ¹ , WANGLin ² , SUNYu ¹

1. Department of Sport Medicine and Joint Surgery, the First Affiliated Hospital of China Medical University, Shenyang Liaoning, 110001, P. R. China;
2. Department of Orthopaedics, the Fourth Affiliated Hospital of China Medical University, Shenyang Liaoning, 110001, P. R. China;

Corresponding author：

BAIXizhuang, Email: zpmhh@sina.com

Keywords：

Medial collateral ligament injury; Tibial Inlay technique; Achilles tendon allograft; Anatomical reconstruction

DOI：

10.7507/1002-1892.20140048

Video：

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Objective To evaluate the clinical results of the tibial Inlay technique for the medial collateral ligament (MCL) reconstruction using Achilles tendon allograft in recovery of medial instability of the knee. Methods Between January 2011 and December 2012, 21 patients underwent tibial Inlay reconstruction of the MCL using Achilles tendon allograft, and the clinical data were retrospectively analyzed. There were 13 males and 8 females with a mean age of 32 years (range, 19-62 years). Injury was caused by sports in 15 cases and by traffic accident in 6 cases. The disease duration ranged from 15 days to 3 months (mean, 1.5 months). According to International Knee Documentation Committee (IKDC) criteria, 5 cases were classified as degree II and 16 cases as degree III. The results of the valgus stress test were positive in all patients. The complications were observed after operation; IKDC subjective knee score and Lysholm score were used to assess the knee function. Results Bone block fracture occurred in 1 case during operation. Primary healing of incision was obtained in the other cases except 1 case having unhealing incision who was healed after skin grafting. No complications of knee joint stiffness, vascular nerve injury, and infection occurred. All patients were followed up 7-29 months (mean, 18.5 months). At last follow-up, the results of the valgus stress test were negative in 20 cases, and positive (degree I) in 1 case; the other patients had no knee extension or flexion limitation except 1 patient having 15° flexion limitation. The Lysholm score was significantly improved from 45.4±13.6 to 87.5±9.4, the IKDC 2000 subjective score was significantly improved from 46.5±14.0 to 88.4±9.3 at last follow-up (P<0.05). MRI showed that the reconstructed MCL was continuous. Conclusion The short-term clinical results of the tibial Inlay technique for MCL reconstruction using Achilles tendon allograft are satisfactory. The Inlay technique for MCL reconstruction can provide good medial stability of the knee, but the lorg-term effectiveness needs further follow-up.

Citation： ZHANGHangzhou, BAIXizhuang, WANGLin, SUNYu. TIBIAL Inlay RECONSTRUCTION OF MEDIAL COLLATERAL LIGAMENT USING Achilles ALLOGRAFT. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(2): 223-226. doi: 10.7507/1002-1892.20140048 Copy

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2.	Wijdicks CA,Griffith CJ,Johansen S,et al.Injuries to the medial collateral ligament and associated medial structures of the knee.J Bone Joint Surg (Am),2010,92(5):1266-1280.
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7.	Lind M,Jakobsen BW,Lund B,et al.Anatomical reconstruction of the medial collateral ligament and posteromedial corner of the knee in patients with chronic medial collateral ligament instability.Am J Sports Med,2009,37(6):1116-1122.
8.	Kim SJ,Lee DH,Kim TE,et al.Concomitant reconstruction of the medial collateral and posterior oblique ligaments for medial instability of the knee.J Bone Joint Surg (Br),2008,90(10):1323-1327.
9.	Marx RG,Hetsroni I.Surgical technique:medial collateral ligament reconstruction using Achilles allograft for combined knee ligament injury.Clin Orthop Relat Res,2012,470(3):798-805.
10.	Lysholm J,Gillquist J.Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale.Am J Sports Med,1982,10(3):150-154.
11.	Anderson AF,Irrgang JJ,Kocher MS,et al.The International Knee Documentation Committee subjective knee evaluation form:normative data.Am J Sports Med,2006,34(1):128-135.
12.	Feeley BT,Muller MS,Allen AA,et al.Biomechanical comparison of medial collateral ligament reconstructions using computer-assisted navigation.Am J Sports Med,2009,37(6):1123-1130.
13.	Jones L,Bismil Q,Alyas F,et al.Persistent symptoms following non operative management in low grade MCL injury of the knee-The role of the deep MCL.Knee,2009,16(1):64-68.
14.	Zhang H,Bai X,Sun Y,et al.Tibial inlay reconstruction of the medial collateral ligament using Achilles tendon allograft for the treatment of medial instability of the knee.Knee Surg Sports Traumatol Arthrosc,2013.[Epub ahead of print].
15.	Brand JC Jr,Pienkowski D,Steelage E,et al.Interference screw fixation strength of a quadrupled hamstring tendon graft is directly related to bone mineral density and insertion torque.Am J Sports Med,2000,28(5):705-710.
16.	Fanelli GC,Tomaszewski DJ.Allograft use in the treatment of the multiple ligament injured knee.Sports Med Arthrosc,2007,15(3):139-148.
17.	Feeley BT,Muller MS,Allen AA,et al.Isometry of medial collateral ligament reconstruction.Knee Surg Sports Traumatol Arthrosc,2009,17(9):1078-1082.

1. Azar FM.Evaluation and treatment of chronic medial collateral ligament injuries of the knee.Sports Med Arthrosc,2006,14(2):84-90.
2. Wijdicks CA,Griffith CJ,Johansen S,et al.Injuries to the medial collateral ligament and associated medial structures of the knee.J Bone Joint Surg (Am),2010,92(5):1266-1280.
3. Grant JA,Tannenbaum E,Miller BS,et al.Treatment of combined complete tears of the anterior cruciate and medial collateral ligaments.Arthroscopy,2012,28(1):110-122.
4. Fanelli GC,Harris JD.Surgical treatment of acute medial collateral ligament and posteromedial corner injuries of the knee.Sports Med Arthrosc,2006,14(2):78-83.
5. Koga H,Muneta T,Yagishita K,et al.Surgical management of grade 3 medial knee injuries combined with cruciate ligament injuries.Knee Surg Sports Traumatol Arthrosc,2012,20(1):88-94.
6. Yoshiya S,Kuroda R,Mizuno K,et al.Medial collateral ligament reconstruction using autogenous hamstring tendons:technique and results in initial cases.Am J Sports Med,2005,33(9):1380-1385.
7. Lind M,Jakobsen BW,Lund B,et al.Anatomical reconstruction of the medial collateral ligament and posteromedial corner of the knee in patients with chronic medial collateral ligament instability.Am J Sports Med,2009,37(6):1116-1122.
8. Kim SJ,Lee DH,Kim TE,et al.Concomitant reconstruction of the medial collateral and posterior oblique ligaments for medial instability of the knee.J Bone Joint Surg (Br),2008,90(10):1323-1327.
9. Marx RG,Hetsroni I.Surgical technique:medial collateral ligament reconstruction using Achilles allograft for combined knee ligament injury.Clin Orthop Relat Res,2012,470(3):798-805.
10. Lysholm J,Gillquist J.Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale.Am J Sports Med,1982,10(3):150-154.
11. Anderson AF,Irrgang JJ,Kocher MS,et al.The International Knee Documentation Committee subjective knee evaluation form:normative data.Am J Sports Med,2006,34(1):128-135.
12. Feeley BT,Muller MS,Allen AA,et al.Biomechanical comparison of medial collateral ligament reconstructions using computer-assisted navigation.Am J Sports Med,2009,37(6):1123-1130.
13. Jones L,Bismil Q,Alyas F,et al.Persistent symptoms following non operative management in low grade MCL injury of the knee-The role of the deep MCL.Knee,2009,16(1):64-68.
14. Zhang H,Bai X,Sun Y,et al.Tibial inlay reconstruction of the medial collateral ligament using Achilles tendon allograft for the treatment of medial instability of the knee.Knee Surg Sports Traumatol Arthrosc,2013.[Epub ahead of print].
15. Brand JC Jr,Pienkowski D,Steelage E,et al.Interference screw fixation strength of a quadrupled hamstring tendon graft is directly related to bone mineral density and insertion torque.Am J Sports Med,2000,28(5):705-710.
16. Fanelli GC,Tomaszewski DJ.Allograft use in the treatment of the multiple ligament injured knee.Sports Med Arthrosc,2007,15(3):139-148.
17. Feeley BT,Muller MS,Allen AA,et al.Isometry of medial collateral ligament reconstruction.Knee Surg Sports Traumatol Arthrosc,2009,17(9):1078-1082.

Chinese Journal of Reparative and Reconstructive Surgery

TIBIAL Inlay RECONSTRUCTION OF MEDIAL COLLATERAL LIGAMENT USING Achilles ALLOGRAFT

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