Comparison of Complete Distal Release of the Medial Collateral Ligament and Medial Epicondylar Osteotomy during Ligament Balancing in Varus Knee Total Knee Arthroplasty

BACKGROUND: During ligament balancing for severe medial contracture in varus knee total knee arthroplasty (TKA), complete distal release of the medial collateral ligament (MCL) or a medial epicondylar osteotomy can be necessary if a large amount of correction is needed. METHODS: This study retrospectively reviewed 9 cases of complete distal release of the MCL and 11 cases of medial epicondylar osteotomy which were used to correct severe medial contracture. The mean follow-up periods were 46.5 months (range, 36 to 78 months) and 39.8 months (range, 32 to 65 months), respectively. RESULTS: There were no significant differences in the clinical results between the two groups. However, the valgus stress radiograph revealed significant differences in medial instability. In complete distal release of the MCL, some stability was obtained by repair and bracing but the medial instability could not be removed completely. CONCLUSIONS: Medial epicondylar osteotomy for a varus deformity in TKA could provide constant medial stability and be a useful ligament balancing technique.

Quantitative and descriptive analysis of the meniscotibial ligament in human corpses

The meniscotibial ligaments (LMT) of humans are capsular fibers with proximal origin in the lateral border of the menisci and distal insertion in the lateral border of the tibial condyle, also called coronary ligament of the knee. However, few studies describe the presence, course and anatomical variations of this ligament. Our objective was to evaluate the LMT through quantitative and descriptive methods. Eighty-five knees were examined(42 right knees [RK] and 43 left knees [LK]), dissected, evaluated, catalogued and photographed by four examiners. Twenty knees (23.53%) presented LMT, 6 (30%) in RK and 14 (70%) in LK. In two RKs, the LMT presented proximal insertion in the medial menisci and distal insertion in medial tibial condyle; in the other ones, the LMT presented proximal insertion in the lateral menisci and distal insertion in the lateral tibial condyle. In the LK, four LMT presented proximal insertion in the medial menisci and distal insertion in the medial tibial condyle, while the other ones presented proximal insertion in the lateral menisci and distal insertionin the lateral tibial condyle. One LMT in the LK presented proximal and distal insertion in both menisci and tibial condyle. The analysis of human corpses in our study suggests that the presence of the LMT is much more common in the LK than in the RK, with more frequent insertion in the proximal region of the lateral menisci and distal insertion in the lateral tibial condyle.

Tratamiento quirúrgico de las lesiones del complejo cápsulo-ligamentario medial de la rodilla: reforzamiento aponeurótico / Surgical treatment for injuries of the medial capsulo-ligamentous complex of the knee aponeuriotic reinforcement

El diagnóstico de las lesiones del complejo cápsulo-ligamentario medial es clínico y de confirmación con resonancia magnética y artroscopia. Se requiere unificar criterios en cuanto el conocimiento y clasificación de los diferentes tipos de inestabilidad de la rodilla así como su estudio clínico mediante diferentes signos. Según su tipo de inestabilidad de la rodilla puede ser un plano, rotacional o combinada y según su magnitud puede ser del grado I a IV. En el Hospital Central Militar y otros hospitales tratamos quirúrgicamente mediante reforzamiento aponeurótico a 42 pacientes (44 rodillas), con lesión del complejo cápsulo-ligamentario medial puro o asociado con otras lesiones, grados III o IV, en un periodo de ocho años, con un seguimiento promedio de 3.5 años. Se calificaron los resultados según fue su incorporación completa a sus actividades cotidianas, militares y deportivas, dolor, valoración radiográfica y clínica. El programa de rehabilitación postquirúrgica fue de cuatro meses. Los resultados observados fueron muy buenos en 26 (62 por ciento), buenos en ocho (19 por ciento), regulares en cuatro (9.5 por ciento) e igual número de malos (9.5 por ciento)