Effect of posterior oblique ligament repair on rotational stability of knee joint_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

HE Qingsong , LIANG Qingwei ,  ZHANG Hangzhou

Department of Orthopaedics, the First Affiliated Hospital of China Medical University, Shenyang Liaoning, 110001, P.R.China;

Corresponding author：

ZHANG Hangzhou, Email: zhanghz1000@163.com

Keywords：

Medial instability of knee; medial collateral ligament; posterior oblique ligament; ligament repair

DOI：

10.7507/1002-1892.201810012

Video：

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Objective To investigate effect of posterior oblique ligament (POL) repair on the rotational stability of the knee joint for the medial collateral ligament (MCL) combined with anterior cruciate ligament (ACL) ruptures.Methods The clinical data of 50 patients (50 knees) with grade-3 MCL-ACL combined injuries who met the selection criteria between January 2013 and December 2015 were retrospectively analyzed. All ACLs were reconstructed with autogenous tendon and the superficial and deep layers of MCLs were sutured; then, POLs were also sutured in 25 patients of repair group and only received conservation treatment postoperatively in 25 patients of conservation group. There was no significant difference in gender, age, disease duration, and preoperative KT-1000 measuring, medial joint space opening, International Knee Documentation Committee (IKDC) score, visual analogue scale (VAS) score, and knee range of motion between the two groups (P>0.05).Results All incisions of the two groups healed by first intention, no surgical related complications occurred. All patients were followed up, with follow-up time of 28-56 months (mean, 38.1 months) in repair group and 26-55 months (mean, 29.1 months) in conservation group. At last follow-up, the IKDC score, VAS score, KT-1000 measuring, medial joint space opening, and knee range of motion significantly improved in the two groups when compared with preoperative ones (P<0.05); but there was no significant difference between the two groups (P>0.05). The Slocum test showed that there was no instability of the anterior medial rotation in the two groups.Conclusion The POL repair can’t obtain more medial stability after ACL reconstruction and MCL repair (superficial and deep layers) for patients who have MCL-ACL combined injuries.

Citation： HE Qingsong, LIANG Qingwei, ZHANG Hangzhou. Effect of posterior oblique ligament repair on rotational stability of knee joint. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(5): 551-554. doi: 10.7507/1002-1892.201810012 Copy

1.	Tandogan NR, Kayaalp A. Surgical treatment of medial knee ligament injuries: current indications and techniques. EFORT Open Rev, 2017, 1(2): 27-33.
2.	黄华强, 李箭, 唐新. 膝关节脱位后内侧结构及后外侧角损伤分期分型及诊治体系. 中国修复重建外科杂志, 2017, 31(5): 614-619.
3.	Schafer KA, Tucker S, Griffith T, et al. Distribution of force in the medial collateral ligament complex during simulated clinical tests of knee stability. Am J Sports Med, 2016, 44(5): 1203-1208.
4.	Wijdicks CA, Ewart DT, Nuckley DJ, et al. Structural properties of the primary medial knee ligaments. Am J Sports Med, 2010, 38(8): 1638-1646.
5.	Madonna V, Screpis D, Condello V, et al. A novel technique for combined medial collateral ligament and posterior oblique ligament reconstruction: technical note. Knee Surg Sports Traumatol Arthrosc, 2015, 23(10): 2814-2819.
6.	Tibor LM, Marchant MH Jr, Taylor DC, et al. Management of medial-sided knee injuries, part 2: posteromedial corner. Am J Sports Med, 2011, 39(6): 1332-1340.
7.	Miyamoto RG, Bosco JA, Sherman OH. Treatment of medial collateral ligament injuries. J Am Acad Orthop Surg, 2009, 17(3): 152-161.
8.	Ateschrang A, Döbele S, Freude T, et al. Acute MCL and ACL injuries: first results of minimal-invasive MCL ligament bracing with combined ACL single-bundle reconstruction. Arch Orthop Trauma Surg, 2016, 136(9): 1265-1272.
9.	Sims WF, Jacobson KE. The posteromedial corner of the knee: medial-sided injury patterns revisited. Am J Sports Med, 2004, 32(2): 337-345.
10.	Dale KM, Bailey JR, Moorman CT 3rd. Surgical management and treatment of the anterior cruciate ligament/medial collateral ligament injured knee. Clin Sports Med, 2017, 36(1): 87-103.
11.	Barrett IJ, Krych AJ, Pareek A, et al. Short- to mid-term outcomes of anatomic MCL reconstruction with Achilles tendon allograft after multiligament knee injury. Knee Surg Sports Traumatol Arthrosc, 2018, 26(10): 2952-2959.
12.	Kremen TJ, Polakof LS, Rajaee SS, et al. The effect of Hamstring tendon autograft harvest on the restoration of knee stability in the setting of concurrent anterior cruciate ligament and medial collateral ligament injuries. Am J Sports Med, 2018, 46(1): 163-170.
13.	张杭州, 梁庆威, 雷则鸣, 等. 多发韧带损伤中严重内侧副韧带断裂不同治疗方式的比较研究. 中国修复重建外科杂志, 2016, 30(8): 956-960.
14.	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.
15.	LaPrade RF, Wijdicks CA. Surgical technique: development of an anatomic medial knee reconstruction. Clin Orthop Relat Res, 2012, 470(3): 806-814.
16.	Dong JT, Chen BC, Men XQ, et al. Application of triangular vector to functionally reconstruct the medial collateral ligament with double-bundle allograft technique. Arthroscopy, 2012, 28(10): 1445-1453.
17.	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.
18.	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.

1. Tandogan NR, Kayaalp A. Surgical treatment of medial knee ligament injuries: current indications and techniques. EFORT Open Rev, 2017, 1(2): 27-33.
2. 黄华强, 李箭, 唐新. 膝关节脱位后内侧结构及后外侧角损伤分期分型及诊治体系. 中国修复重建外科杂志, 2017, 31(5): 614-619.
3. Schafer KA, Tucker S, Griffith T, et al. Distribution of force in the medial collateral ligament complex during simulated clinical tests of knee stability. Am J Sports Med, 2016, 44(5): 1203-1208.
4. Wijdicks CA, Ewart DT, Nuckley DJ, et al. Structural properties of the primary medial knee ligaments. Am J Sports Med, 2010, 38(8): 1638-1646.
5. Madonna V, Screpis D, Condello V, et al. A novel technique for combined medial collateral ligament and posterior oblique ligament reconstruction: technical note. Knee Surg Sports Traumatol Arthrosc, 2015, 23(10): 2814-2819.
6. Tibor LM, Marchant MH Jr, Taylor DC, et al. Management of medial-sided knee injuries, part 2: posteromedial corner. Am J Sports Med, 2011, 39(6): 1332-1340.
7. Miyamoto RG, Bosco JA, Sherman OH. Treatment of medial collateral ligament injuries. J Am Acad Orthop Surg, 2009, 17(3): 152-161.
8. Ateschrang A, Döbele S, Freude T, et al. Acute MCL and ACL injuries: first results of minimal-invasive MCL ligament bracing with combined ACL single-bundle reconstruction. Arch Orthop Trauma Surg, 2016, 136(9): 1265-1272.
9. Sims WF, Jacobson KE. The posteromedial corner of the knee: medial-sided injury patterns revisited. Am J Sports Med, 2004, 32(2): 337-345.
10. Dale KM, Bailey JR, Moorman CT 3rd. Surgical management and treatment of the anterior cruciate ligament/medial collateral ligament injured knee. Clin Sports Med, 2017, 36(1): 87-103.
11. Barrett IJ, Krych AJ, Pareek A, et al. Short- to mid-term outcomes of anatomic MCL reconstruction with Achilles tendon allograft after multiligament knee injury. Knee Surg Sports Traumatol Arthrosc, 2018, 26(10): 2952-2959.
12. Kremen TJ, Polakof LS, Rajaee SS, et al. The effect of Hamstring tendon autograft harvest on the restoration of knee stability in the setting of concurrent anterior cruciate ligament and medial collateral ligament injuries. Am J Sports Med, 2018, 46(1): 163-170.
13. 张杭州, 梁庆威, 雷则鸣, 等. 多发韧带损伤中严重内侧副韧带断裂不同治疗方式的比较研究. 中国修复重建外科杂志, 2016, 30(8): 956-960.
14. 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.
15. LaPrade RF, Wijdicks CA. Surgical technique: development of an anatomic medial knee reconstruction. Clin Orthop Relat Res, 2012, 470(3): 806-814.
16. Dong JT, Chen BC, Men XQ, et al. Application of triangular vector to functionally reconstruct the medial collateral ligament with double-bundle allograft technique. Arthroscopy, 2012, 28(10): 1445-1453.
17. 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.
18. 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.

Chinese Journal of Reparative and Reconstructive Surgery

Effect of posterior oblique ligament repair on rotational stability of knee joint

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