Surgical Technique: Medial Collateral Ligament Reconstruction Using Achilles Allograft for Combined Knee Ligament Injury
Tóm tắt
Previous approaches for medial collateral ligament (MCL) reconstruction have been associated with extensive exposure, risk of donor site morbidity with autografts, loss of motion, nonanatomic graft placement, and technical complexity with double-bundle constructs. Therefore, we implemented a technique that uses Achilles allograft, small incisions, and anatomic insertions to reconstruct the MCL. The MCL femoral insertion was identified, and a socket reamed over a guide pin. The Achilles bone plug was fixed in the socket and the tendon passed distally under the skin and fixed on the tibia, creating isometric reconstruction. We evaluated 14 patients who had this MCL reconstruction. We determined range of knee motion, knee ligament laxity, functional outcome scores (International Knee Documentation Committee [IKDC]-subjective, Lysholm, Knee injury and Osteoarthritis Outcome Score [KOOS]), and activity level scores (Tegner, Marx). Followup range was 24 to 61 months. Knee motion was maintained in 12 cases. Grade 0-1 + valgus stability was obtained in all 14 cases. In cases of MCL with primary ACL reconstruction, IKDC-subjective, Lysholm, and KOOS-sports scores were 91 ± 6, 92 ± 6, and 93 ± 12, respectively, and return to preinjury activity levels was achieved. In cases of MCL with revision ACL reconstruction, function was inferior, and patients did not return to their preinjury activity levels. This technique uses allograft that provides bone-to-bone healing on the femur, requires small incisions, and creates isometric reconstruction. When performed with a cruciate reconstruction, knee stability can be restored at 2 to 5 years followup. In patients with MCL with primary ACL reconstruction, return to preinjury activity level in recreational athletes can be achieved.
Tài liệu tham khảo
Anderson AF, Irrgang JJ, Kocher MS, Mann BJ, Harrast JJ. The International Knee Documentation Committee subjective knee evaluation form: normative data. Am J Sports Med. 2006;34:128–135.
Azar FM. Evaluation and treatment of chronic medial collateral ligament injuries of the knee. Sports Med Arthrosc Rev. 2006;14:84–90.
Battaglia MJ 2nd, Cordasco FA, Hannafin JA, Rodeo SA, O’Brien SJ, Altchek DW, Cavanaugh J, Wickiewicz TL, Warren RF. Results of revision anterior cruciate ligament surgery. Am J Sports Med. 2007;35:2057–2066.
Borden PS, Kantaras AT, Caborn DNM. Medial collateral ligament reconstruction with allograft using a double-bundle technique. Arthroscopy. 2002;18:E19.
Bosworth DM. Transplantation of the semitendinosus for repair of laceration of medial collateral ligament of the knee. J Bone Joint Surg Am. 1952;34:196–202.
Fanelli GC, Boyd JL, Heckler MW. How I manage posterior cruciate ligament injuries. Oper Tech Sports Med. 2009;17:175–193.
Fanelli GC, Edson CJ. Combined posterior cruciate ligament–posterolateral reconstructions with Achilles tendon allograft and biceps femoris tenodesis: 2- to 10-year follow-up. Arthroscopy. 2004;20:339–345.
Fanelli GC, Harris JD. Late medial collateral ligament reconstruction. Tech Knee Surg. 2007;6:99–105.
Fanelli GC, Tomaszewski DJ. Allograft use in the treatment of the multiple ligament injured knee. Sports Med Arthrosc Rev. 2007;15:139–148.
Feeley BT, Muller MS, Allen AA, Granchi CC, Pearle AD. Isometry of medial collateral ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2009;17:1078–1082.
Feeley BT, Muller MS, Allen AA, Granchi CC, Pearle AD. Biomechanical comparison of medial collateral ligament reconstructions using computer-assisted navigation. Am J Sports Med. 2009;37:1123–1130.
Grood ES, Noyes FR, Butler DL, Suntay WJ. Ligamentous and capsular restraints preventing straight medial and lateral laxity in intact human cadaver knees. J Bone Joint Surg Am. 1981;63:1257–1269.
Hughston JC, Barrett GR. Acute anteromedial rotatory instability. Long-term results of surgical repair. J Bone Joint Surg Am. 1983;65:145–153.
Hughston JC, Eilers AF. The role of the posterior oblique ligament in repairs of acute medial (collateral) ligament tears of the knee. J Bone Joint Surg Am. 1973;55:923–940.
Indelicato PA. Non-operative treatment of complete tears of the medial collateral ligament of the knee. J Bone Joint Surg Am. 1983;65:323–329.
Jonsson T, Althoff B, Peterson L, Renstrom P. Clinical diagnosis of ruptures of the anterior cruciate ligament: a comparative study of the Lachman test and the anterior drawer sign. Am J Sports Med. 1982;10:100–102.
Kim SJ, Lee DH, Kim TE, Choi NH. Concomitant reconstruction of the medial collateral and posterior oblique ligaments for medial instability of the knee. J Bone Joint Surg Br. 2008;90:1323–1327.
La Prade RF, Engebretsen AH, Ly TV, Johansen S, Wentorf FA, Engebretsen L. The anatomy of the medial part of the knee. J Bone Joint Surg Am. 2007;89:2000–2010.
Larson RL. Combined instabilities of the knee. Clin Orthop Relat Res. 1980;147:68–75.
Lind M, Jakobsen BW, Lund B, Hansen MS, Abdallah O, Christiansen SE. 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;37:1116–1122.
Lysholm J, Gillquist J. Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med. 1982;10:150–154.
Marx RG, Stump TJ, Jones EC, Wickiewicz TL, Warren RF. Development and evaluation of an activity rating scale for disorders of the knee. Am J Sports Med. 2001;29:213–218.
Mitsou A, Vallianatos P, Piskopakis N, Maheras S. Anterior cruciate ligament reconstruction by over-the-top repair combined with popliteus tendon plasty. J Bone Joint Surg Br. 1990;72:398–404.
Moller E, Weidenhielm L, Werner S. Outcome and knee-related quality of life after anterior cruciate ligament reconstruction: a long term follow-up. Knee Surg Sports Traumatol Arthrosc. 2009;17:786–794.
Odensten M, Lysholm J, Gillquist J. Long-term follow-up study of a distal iliotibial band transfer (DIT) for anterolateral knee instability. Clin Orthop Relat Res. 1983;176:129–135.
Robins AJ, Newman AP, Burks RT. Postoperative return of motion in anterior cruciate ligament and medial collateral ligament injuries: the effect of medial collateral ligament rupture locations. Am J Sports Med. 1993;21:20–25.
Roos EM, Roos HP, Lohmander LS, Ekdahl C, Beynnon BD. Knee injury and Osteoarthritis Outcome Score (KOOS)—development of a self-administered outcome measure. J Orthop Sports Phys Ther. 1998;28:88–96.
Tegner Y, Lysholm J. Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res. 1985;198:43–49.
Veltri DM, Warren RF. Isolated and combined posterior cruciate ligament injuries. J Am Acad Orthop Surg. 1993;1:67–75.
Wijdicks CA, Griffith CJ, Johansen S, Engebretsen L, La Prade RF. Injuries to the medial collateral ligament and associated medial structures of the knee. J Bone Joint Surg Am. 2010;92:1266–1280.
Wright RW, Dunn WR, Amendola A, Andrish JT, Flanigan DC, Jones M, Kaeding CC, Marx RG, Matava MJ, McCarty EC, Parker RD, Vidal A, Wolcott M, Wolf BR, Spindler KP; MOON Cohort. Anterior cruciate ligament revision reconstruction: two-year results from the MOON Cohort. J Knee Surg. 2007;20:308–311.