Objective To explore the effect of the collateral ligaments and the plantar plate on the flexion of the metatarsophalangeal(MP) joints. Methods Twenty-four preserved human No.2-4 digits were obtained from embalmed cadaver feet, which were divided into 2 groups at random. In group A, the bilateral collateral ligaments were cut first, and then the plantar plate was sectioned. They were cut inopposite sequence in group B. Angle of the flexion of MP joint was observed in the same load after the bilateral collateral ligaments and the plantar plate were sectioned in different sequence.From 1994 to 2000,11 cases were used with this technic, including plantar section in 2 cases and both plantar section and bilateral collateral ligamentscut in 9 cases. Results The angle of flexion of the MP joint before operation in group A is 37.30±5.42°, it increased 11.29±2.36° and to 48.60±2.98° when the bilateral collateral ligaments were cut, and there was significant difference. Later the cut of the plantar plate increased another 5.30±1.59° and to 53.35±2.76°. Both have an increasing trend for the angle of flexion of the MP joint (Plt;0.01). While in group B, the angle of flexion of the MP joint before operation is 34.59±5.32°, it increased 6.29±2.98° and to 40.89±2.36° when the plantar plate were cut, laterthe cut of the bilateral collateral ligaments increased another 9.71±1.94° and to 50.60±2.01°. Both had an increasing trend for the angle of flexion ofthe MP joint (Plt;0.01). The bilateral collateral ligaments had more influence than the plantar plate (Plt;0.01). There was the same effect in different sequence (Pgt;0.05). In 2 cases with plantar section, the flexion angle of MP joint could achieve 15° to 45° in 2 monthes. The other 9 cases with both plantar section and bilateral collateral ligaments cut, the MP joint flexion achieved 10.3° to 58.4° in 26.3 months. Conclusion The flexion angle of the MP joint can be increasedby cutting the bilateral collateral ligaments and the plantar plate.
BJECTIVE: To study the effect of transposition of great adductor muscular tendon pedicled vessels in repairing the medial collateral ligament defect of knee joint. METHODS: From September 1991 to September 1999, on the basis study of applied anatomy, 30 patients with the medial collateral ligament defect were repaired with great adductor muscular tendon transposition pedicled vessels. Among them, there were 28 males and 2 females, aged 26 years in average. RESULTS: Followed up for 17 to 60 months, 93.3% patients reached excellent or good grades. No case fell into the poor grade. CONCLUSION: Because the great adductor muscular tendon is adjacent to the knee joint and similar to the knee ligament, it is appropriate to repair knee ligament. Transposition of the great adductor muscular tendon pedicled vessels is effective in the reconstruction of the medial collateral ligament defect of knee joint.
Objective To evaluate of the valgus stability of the elbow after excision of the radial head, release of the medial collateral ligament (MCL), radial head replacement, and medial collateral ligament reconstruction.Methods Twelve fresh human cadaveric elbows were dissected to establish 7 kinds of specimens with elbow joint and ligaments as follow:①intact(n=12)； ②release of the medial collateral ligament(n=6)；③ excision of the radial head(n=6)；④excision of the radial head together with release of the medial collateral ligament(n=12)；⑤radial head replacement(n=6)；⑥medial collateral ligament reconstruction(n=6)；⑦radial head replacement together with medial collateral ligament reconstruction(n=12). Under two-newton-meter valgus torque, and at 0, 30, 60, 90 and 120 degrees of flexion with the forearm in supination, the valgus elbow laxity was quantified: All analysis was performed with SPSS 10.0 software.Results The least valgus laxity was seen in the intact state and its stability was the best. The laxity increased after resection of the radial head. The laxity was more after release of the medial collateral ligament than after resection of the radial head (Plt;0.01). The greatest laxity was observed after release of the medial collateral ligament together with resection of the radial head, so its stability was the worst. The laxity of the following implant of the radial head decreased. The laxity of the medial collateral ligament reconstruction was as much as that of the intact ligament (Pgt;0.05). The laxity of the radial head replacement together with medial collateral ligament reconstruction became less.Conclusion The results of this studyshow that the medial collateral ligament is the primary valgus stabilizer of the elbow and the radial head was a secondary constraint to resist valgus laxity.Both the medial collateral ligament reconstruction and the radial head replacement can restore the stability of elbow. If the radial head replacement can notbe carried out, the reconstruction of the medial collateral ligament is acceptable.
Objective To investigate the effect of anteromedial coronoid facet fracture and lateral collateral ligament complex (LCLC) injury on the posteromedial rotational stability of the elbow joint. Methods The double elbows were obtained from 4 fresh adult male cadaveric specimens. Complete elbow joint (group A,n=8), simple LCLC injury (group B,n=4), simple anteromedial coronoid facet fracture (group C,n=4), and LCLC injury combined with anteromedial coronoid facet fracture (group D,n=8). The torque value was calculated according to the load-displacement curve. Results There was no complete dislocation of the elbow during the experiment. The torque values of groups A, B, C, and D were (10.286±0.166), (5.775±0.124), (6.566±0.139), and (3.004±0.063) N·m respectively, showing significant differences between groups (P<0.05). Conclusion Simple LCLC injury, simple anteromedial coronoid facet fracture, and combined both injury will affect the posteromedial rotational stability of the elbow.
Objective To discuss the effectiveness of operation technique for antero-medial rotatory instability (AMRI) of the knee joint caused by motorcycle. Methods Between June 2007 and December 2009, 32 cases of AMRI caused by motorcycle were treated. There were 28 males and 4 females with an average age of 35.5 years (range, 20-50 years). The interval between injury and surgery was 5-10 days (mean, 7 days). The anterior cruciate ligament (ACL) was injured at the attachment point of the condyles crest; the medial collateral ligament (MCL) was injured at central site in 19 cases, at medial condyles of femur in 10 cases, and at medial condyles of tibia in 3 cases, which were all closed injuries. The bone avulsion of condyles crest was fixed by steel wire and MCL was repaired. Results Red swelling and a little effusion occurred at the incision in 1 case, and the other incisions healed by first intention. Traumatic arthritis of the knee occured in 5 cases. Thirty-two cases were followed up 16-22 months (mean, 18.5 months). The X-ray examination showed that the fracture union time was 5-8 weeks (mean, 6 weeks) after operation. At last follow-up, the extension of knee joint was 0° and the flexion of the knee joint was 110-170° (mean, 155°). According to the synthetic evaluating standard of International Knee Documentation Committee, 24 cases were rated as A level, 6 cases as B, 1 case as C, and 1 case as D at last follow-up. Lysholm knee score was 85.93 ± 3.76 at last follow-up, which was significantly higher (t=53.785, P=0.000) than preoperative score 37.54 ± 3.43. Conclusion In patients with AMRI caused by motorcycle, steel wire is used to fix the bone avulsion of condyles crest and MCL should be repaired simultaneously as far as possible. And associating with the early postoperative functional exercise, the short-term effectiveness is satisfactory, but long-term effectiveness still need further follow-up observation.
ObjectiveTo 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. MethodsBetween 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. ResultsBone 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. ConclusionThe 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.
ObjectiveTo 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.MethodsThe 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).ResultsAll 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.ConclusionThe 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.
ObjectiveTo investigate the effectiveness of arthroscopic GraftLink technique reconstruction combined with suture anchor fixation in treatment of anterior cruciate ligament (ACL) rupture and medial collateral ligament (MCL) grade Ⅲ injury.MethodsBetween June 2015 and February 2018, 28 patients with ACL rupture and MCL grade Ⅲ injury were treated. Arthroscopic GraftLink technique was used to reconstruct ACL with autologous peroneus longus tendon (PLT), and suture anchor fixation was used to repair MCL. There were 22 males and 6 females, aged 21-47 years, with an average age of 30.4 years. The cause of injury included traffic accident in 18 cases, falling from height in 7 cases, and sports injury in 3 cases. The time from injury to admission was 1-2 weeks, with an average of 1.3 weeks. The preoperative Lysholm score of knee joint was 46.8±3.0 and the International Knee Documentation Commission (IKDC) score was 49.2±2.7. The American Orthopaedic Foot and Ankle Society (AOFAS) score of ankle joint was 98.29±0.72. Both Lachman test and valgus stress test were positive. There were 8 cases of meniscus injury and 2 cases of cartilage injury.ResultsThe operation time ranged from 55 to 90 minutes, with an average of 72.5 minutes. All incisions healed by first intention after operation, and no complications related to operation occurred. All patients were followed up 6-38 months, with an average of 20.7 months. At 3 months after operation, the range of motion of the knee joint was 116- 132°, with an average of 122°. Lachman test showed that the anterior translation more than 5 mm in 2 cases, and the others were negative; while the valgus stress test showed that all patients were positive. At 6 months after operation, the Lysholm score and IKDC score of knee joint were 90.2±1.8 and 93.5±2.3, respectively, which were significantly higher than preoperative scores (t=31.60, P=0.00; t=29.91, P=0.01); AOFAS score of ankle joint was 97.86±0.68, with no significant difference compared with preoperative score (t=2.89, P=0.08). KT-1000 test showed that the difference of anterior relaxation between bilateral knee joints was less than 2 mm in 25 cases and 3 to 5 mm in 3 cases.ConclusionThe method of ACL reconstruction via arthroscopic GraftLink technique with PLT and MCL repair via suture anchor fixation has the advantages of less knee injury and faster recovery, and there is no significant impact on ankle function after tendon removal.
ObjectiveTo compare the clinical efficacy between medial collateral ligament (MCL) repair and MCL reconstruction in multi-ligament injury. MethodsThirty-one patients with MCL rupture and multi-ligament injury of knee joint were treated between August 2008 and August 2012, and the clinical data were retrospectively analyzed. Of 31 patients, 11 cases underwent MCL repair (repair group), and 20 cases underwent MCL reconstruction (reconstruction group). There was no significant difference in gender, age, body mass, injury side, injury cause, and preoperative knee Lyshlom score, International Knee Documentation Committee (IKDC) subjective score, range of motion, and medial joint opening between 2 groups (P > 0.05). The postoperative knee subjective function and stability were compared between 2 groups. ResultsAll incisions healed by first intention, and no postoperative complication occurred. All patients were followed up 2-4 years (mean, 3.2 years). At 2 years after operation, the IKDC subjective score, Lyshlom score, and range of motion were significantly increased in 2 groups when compared with preoperative ones (P < 0.05). The range of motion of reconstruction group was significantly better than that of repair group (P < 0.05). No significant difference was found in IKDC subjective score and Lyshlom score between 2 groups (P > 0.05). The medial joint opening was significantly improved in 2 groups at 2 years after operation when compared with preoperative one (P < 0.05), but no significant difference was found between 2 groups (P > 0.05). ConclusionBoth the MCL reconstruction and MCL repair can restore medial stability in multi-ligament injury, but MCL reconstruction is better than MCL repair in range of motion.
ObjectiveTo summarize the prevention and treatment of iatrogenic medial collateral ligament (MCL) injuries in total knee arthroplasty (TKA).MethodsThe relevant literature about iatrogenic MCL injuries in TKA was summarized, and the symptoms, causes, preventions, and treatments were analyzed.ResultsPreventions on the iatrogenic MCL injuries in TKA is significantly promoted. With the occurrence of MCL injuries, the femoral avulsion can be fixed with the screw and washer or the suture anchors; the tibial avulsion can be treated with the suture anchors fixation, bone staples fixation, or conservative treatment; the mid-substance laceration can be repaired directly; the autologous quadriceps tendon, semitendinosus tendon, or artificial ligament can be used for the patients with poor tissue conditions or obvious residual gap between the ligament ends; the use of implant with greater constraint can be the last alternative method.ConclusionNo consensus has been reached to the management of iatrogenic MCL injuries in TKA. Different solutions and strategies can be integrated and adopted flexibly by surgeons according to the specific situation.