Biomechanical comparison of single-bundle and anatomical double-bundle reconstructions for grade <b>Ⅲ</b> medial collateral ligament injury_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

XIE Weiyong ^1,2 ,  ZHU Weimin ^1,3

1. Guangzhou Medical University, Guangzhou Guangdong, 511436, P.R.China;
2. Department of Sports Medicine, Orthopedic Hospital of Longgang, Shenzhen Guangdong, 518000, P.R.China;
3. Department of Sports Medicine, Second People’s Hospital, Shenzhen Guangdong, 518002, P.R.China;

Corresponding author：

ZHU Weimin, Email: 13570879119@126.com

Keywords：

Knee joint; medial collateral ligament; superficial medial collateral ligament; posterior oblique ligament; anatomical reconstruction; biomechanics

DOI：

10.7507/1002-1892.201911057

Video：

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Objective To evaluate and compare knee joint stability of grade Ⅲ medial collateral ligament (MCL) injury treated by single-bundle and anatomical double-bundle reconstruction methods, thus providing biomechanical basis for clinical treatment.Methods Nine fresh cadaver specimens of normal human knee joints were randomly divided into 3 groups on average. In intact MCL group: The anterior cruciate ligament (ACL) was detached and reconstructed with single-bundle techniques, and the MCL was intact. In single-bundle and double-bundle reconstruction groups, the superficial MCL (sMCL), posterior oblique ligament (POL), and ACL were all detached to manufacturing grade Ⅲ MCL injury models. After single-bundle reconstruction of ACL, the sMCL single-bundle reconstruction and anatomical double-bundle reconstruction of sMCL and POL were performed, respectively. Biomechanical evaluation indexes included anterior tibial translation (ATT), internal rotation (IR), valgus rotation (VAL), and stresses of MCL and ACL under internal rotation and valgus torques at different ranges of motion of the knee joint.Results There was no significant difference in ATT at full extension and flexion of 15°, 30°, 45°, 60°, and 90° between groups (P>0.05). At full extension and flexion of 15°, the IR and VAL were significantly higher in single-bundle reconstruction group than in double-bundle reconstruction group and intact MCL group (P<0.05). At flexion of 30°, the VAL was significantly higher in single-bundle reconstruction group than in double-bundle reconstruction group and intact MCL group (P<0.05). While there was no significant difference between double-bundle reconstruction group and intact MCL group (P>0.05). There was no significant difference in the stresses of MCL and ACL between groups under the internal rotation and valgus torques at all positions (P>0.05).Conclusion MCL anatomical double-bundle reconstruction can acquire better valgus and rotational stability of the knee joint compared with single-bundle reconstruction.

Citation： XIE Weiyong, ZHU Weimin. Biomechanical comparison of single-bundle and anatomical double-bundle reconstructions for grade Ⅲ medial collateral ligament injury. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(6): 720-725. doi: 10.7507/1002-1892.201911057 Copy

1.	Grood ES, Noyes FR, Butler DL, et al. Ligamentous and capsular restraints preventing straight medial and lateral laxity in intact human cadaver knees. J Bone Joint Surg (Am), 1981, 63(8): 1257-1269.
2.	Warren LA, Marshall JL, Girgis F. The prime static stabilizer of the medical side of the knee. J Bone Joint Surg (Am), 1974, 56(4): 665-674.
3.	Griffith CJ, Wijdicks CA, LaPrade RF, et al. Force measurements on the posterior oblique ligament and superficial medial collateral ligament proximal and distal divisions to applied loads. Am J Sports Med, 2009, 37(1): 140-148.
4.	Haimes JL, Wroble RR, Grood ES, et al. Role of the medial structures in the intact and anterior cruciate ligament-deficient knee. Limits of motion in the human knee. Am J Sports Med, 1994, 22(3): 402-409.
5.	Griffith CJ, LaPrade RF, Johansen S, et al. Medial knee injury: Part 1, static function of the individual components of the main medial knee structures. Am J Sports Med, 2009, 37(9): 1762-1770.
6.	Butler DL, Noyes FR, Grood ES. Ligamentous restraints to anterior-posterior drawer in the human knee. A biomechanical study. J Bone Joint Surg (Am), 1980, 62(2): 259-270.
7.	Hughston JC. The importance of the posterior oblique ligament in repairs of acute tears of the medial ligaments in knees with and without an associated rupture of the anterior cruciate ligament. Results of long-term follow-up. J Bone Joint Surg (Am), 1994, 76(9): 1328-1344.
8.	Ballmer PM, Jakob RP. The non operative treatment of isolated complete tears of the medial collateral ligament of the knee. A prospective study. Arch Orthop Trauma Surg, 1988, 107(5): 273-276.
9.	Halinen J, Lindahl J, Hirvensalo E, et al. Operative and nonoperative treatments of medial collateral ligament rupture with early anterior cruciate ligament reconstruction: a prospective randomized study. Am J Sports Med, 2006, 34(7): 1134-1140.
10.	Kannus P. Long-term results of conservatively treated medial collateral ligament injuries of the knee joint. Clin Orthop Relat Res, 1988, (226): 103-112.
11.	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.
12.	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.
13.	Kremen TJ, Polakof LS, Rajaee SS, et al. The effect of hamstring tendon autograftharvest 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.
14.	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.
15.	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.
16.	Wijdicks CA, Griffith CJ, LaPrade RF, et al. Medial knee injury: Part 2, load sharing between the posterior oblique ligament and superficial medial collateral ligament. Am J Sports Med, 2009, 37(9): 1771-1776.
17.	Coobs BR, Wijdicks CA, Armitage BM, et al. An in vitro analysis of an anatomical medial knee reconstruction. Am J Sports Med, 2010, 38(2): 339-347.
18.	LaPrade RF, Wijdicks CA. Surgical technique: development of an anatomic medial knee reconstruction. Clin Orthop Relat Res, 2012, 470(3): 806-814.
19.	吴成, 谢国庆, 金文孝, 等. 关节镜下 GraftLink 技术重建联合带线锚钉固定治疗前交叉韧带合并内侧副韧带损伤. 中国修复重建外科杂志, 2019, 33(6): 685-688.
20.	张杭州, 白希壮, 梁庆威, 等. 膝关节内侧副韧带完全断裂时内侧副韧带深层损伤治疗方法比较. 中国修复重建外科杂志, 2016, 30(3): 363-367.
21.	Joshi A, Singh N, Thapa S, et al. Weave technique for reconstruction of medial collateral ligament and posterior oblique ligament: an anatomic approach using semitendinosus tendon. Arthrosc Tech, 2019, 8(11): e1417-e1423.
22.	Crawford MD, Kennedy MI, Bernholt DL, et al. Combined posterior cruciate ligament and superficial medial collateral ligament knee reconstruction: avoiding tunnel convergence. Arthrosc Tech, 2019, 8(8): e929-e933.
23.	Kim MS, Koh IJ, In Y. Superficial and deep medial collateral ligament reconstruction for chronic medial instability of the knee. Arthrosc Tech, 2019, 8(6): e549-e554.
24.	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.
25.	Wang X, Liu H, Duan G, et al. A biomechanical analysis of triangular medial knee reconstruction. BMC Musculoskelet Disord, 2018, 19(1): 125.

1. Grood ES, Noyes FR, Butler DL, et al. Ligamentous and capsular restraints preventing straight medial and lateral laxity in intact human cadaver knees. J Bone Joint Surg (Am), 1981, 63(8): 1257-1269.
2. Warren LA, Marshall JL, Girgis F. The prime static stabilizer of the medical side of the knee. J Bone Joint Surg (Am), 1974, 56(4): 665-674.
3. Griffith CJ, Wijdicks CA, LaPrade RF, et al. Force measurements on the posterior oblique ligament and superficial medial collateral ligament proximal and distal divisions to applied loads. Am J Sports Med, 2009, 37(1): 140-148.
4. Haimes JL, Wroble RR, Grood ES, et al. Role of the medial structures in the intact and anterior cruciate ligament-deficient knee. Limits of motion in the human knee. Am J Sports Med, 1994, 22(3): 402-409.
5. Griffith CJ, LaPrade RF, Johansen S, et al. Medial knee injury: Part 1, static function of the individual components of the main medial knee structures. Am J Sports Med, 2009, 37(9): 1762-1770.
6. Butler DL, Noyes FR, Grood ES. Ligamentous restraints to anterior-posterior drawer in the human knee. A biomechanical study. J Bone Joint Surg (Am), 1980, 62(2): 259-270.
7. Hughston JC. The importance of the posterior oblique ligament in repairs of acute tears of the medial ligaments in knees with and without an associated rupture of the anterior cruciate ligament. Results of long-term follow-up. J Bone Joint Surg (Am), 1994, 76(9): 1328-1344.
8. Ballmer PM, Jakob RP. The non operative treatment of isolated complete tears of the medial collateral ligament of the knee. A prospective study. Arch Orthop Trauma Surg, 1988, 107(5): 273-276.
9. Halinen J, Lindahl J, Hirvensalo E, et al. Operative and nonoperative treatments of medial collateral ligament rupture with early anterior cruciate ligament reconstruction: a prospective randomized study. Am J Sports Med, 2006, 34(7): 1134-1140.
10. Kannus P. Long-term results of conservatively treated medial collateral ligament injuries of the knee joint. Clin Orthop Relat Res, 1988, (226): 103-112.
11. 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.
12. 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.
13. Kremen TJ, Polakof LS, Rajaee SS, et al. The effect of hamstring tendon autograftharvest 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.
14. 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.
15. 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.
16. Wijdicks CA, Griffith CJ, LaPrade RF, et al. Medial knee injury: Part 2, load sharing between the posterior oblique ligament and superficial medial collateral ligament. Am J Sports Med, 2009, 37(9): 1771-1776.
17. Coobs BR, Wijdicks CA, Armitage BM, et al. An in vitro analysis of an anatomical medial knee reconstruction. Am J Sports Med, 2010, 38(2): 339-347.
18. LaPrade RF, Wijdicks CA. Surgical technique: development of an anatomic medial knee reconstruction. Clin Orthop Relat Res, 2012, 470(3): 806-814.
19. 吴成, 谢国庆, 金文孝, 等. 关节镜下 GraftLink 技术重建联合带线锚钉固定治疗前交叉韧带合并内侧副韧带损伤. 中国修复重建外科杂志, 2019, 33(6): 685-688.
20. 张杭州, 白希壮, 梁庆威, 等. 膝关节内侧副韧带完全断裂时内侧副韧带深层损伤治疗方法比较. 中国修复重建外科杂志, 2016, 30(3): 363-367.
21. Joshi A, Singh N, Thapa S, et al. Weave technique for reconstruction of medial collateral ligament and posterior oblique ligament: an anatomic approach using semitendinosus tendon. Arthrosc Tech, 2019, 8(11): e1417-e1423.
22. Crawford MD, Kennedy MI, Bernholt DL, et al. Combined posterior cruciate ligament and superficial medial collateral ligament knee reconstruction: avoiding tunnel convergence. Arthrosc Tech, 2019, 8(8): e929-e933.
23. Kim MS, Koh IJ, In Y. Superficial and deep medial collateral ligament reconstruction for chronic medial instability of the knee. Arthrosc Tech, 2019, 8(6): e549-e554.
24. 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.
25. Wang X, Liu H, Duan G, et al. A biomechanical analysis of triangular medial knee reconstruction. BMC Musculoskelet Disord, 2018, 19(1): 125.

Chinese Journal of Reparative and Reconstructive Surgery

Biomechanical comparison of single-bundle and anatomical double-bundle reconstructions for grade Ⅲ medial collateral ligament injury

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