Repair of Intraoperative Injury to the Medial Collateral Ligament During Primary Total Knee Arthroplasty

2016 ◽  
Vol 98 (1) ◽  
pp. 35-39 ◽  
Author(s):  
Daniel D. Bohl ◽  
Nathan G. Wetters ◽  
Daniel J. Del Gaizo ◽  
Joshua J. Jacobs ◽  
Aaron G. Rosenberg ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Medial Collateral Ligament ◽  
Primary Total Knee Arthroplasty ◽  
Collateral Ligament ◽  
Total Knee ◽  
Primary Total Knee

scholarly journals Management of Medial Collateral Ligament Injury During Primary Total Knee Arthroplasty: A Systematic Review

2014 ◽  
Vol 4 (2) ◽  
pp. 17-23 ◽  
Author(s):  
Paul Della Torre, MD ◽  
Andrew Stephens, MD ◽  
Horng Lii Oh, MD ◽  
Akshay Kamra, MD ◽  
Bernard Zicat, MD ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Medial Collateral Ligament ◽  
Primary Total Knee Arthroplasty ◽  
Ligament Injury ◽  
Collateral Ligament ◽  
Direct Repair ◽  
Medial Collateral Ligament Injury ◽  
Total Knee ◽  
Primary Total Knee

Medial collateral ligament injury during primary total knee arthroplasty is a recognised complication potentially resulting in valgus instability, suboptimal patient outcomes and a higher rate of revision or reoperation. Options for management include primary repair with or without augmentation, reconstruction or immediate conversion to prosthesis with greater constraint, in conjunction with various postoperative rehabilitation protocols. Inconsistent recommendations throughout the orthopaedic literature have made the approach to managing this complication problematic. The objective of this study was to review the available literature to date comparing intraoperative and postoperative management options for primary total knee arthroplasty complicated by recognised injury to the medial collateral ligament. This systematic literature review was prospectively registered with PROSPERO (#CRD42014008866) and performed in accordance with PRISMA guidelines including a PRISMA flow diagram. Five articles satisfied the inclusion criteria. Each was a retrospective, observational cohort or case series with small numbers reported, inconsistent methodology and incompletely reported outcomes. Four of the five studies managing medial collateral ligament injury during total knee arthroplasty (47/84 patients) with direct repair with or without autograft augmentation reported good outcomes with no revision or reoperation required for symptomatic instability over a follow-up period of 16 months to almost 8 years. The fifth study with a follow-up to 10 years and a high rate of conversion to unlinked semi constrained total knee arthroplasty implant (30/37 patients) reported a greater incidence of revision due to instability, in patients in whom the medial collateral ligament injury was directly repaired without added constraint. Overall balance of evidence is in favour of satisfactory outcomes without symptomatic instability following direct repair with or without augmentation of an medial collateral ligament injury recognised intraoperatively during total knee arthroplasty. An implant with greater constraint may have reduced longevity in younger, more active patients through aseptic loosening. In elderly or less mobile patients, and in situations where the medial collateral ligament repair is deemed poor quality or incomplete, an implant with greater constraint would seem prudent. In patients where direct repair with or without augmentation was used, a period of 4-6 weeks of unrestricted rehabilitation in a hinged knee brace should be followed.

Managing Superficial Distal Medial Collateral Ligament Insufficiency in Primary Total Knee Arthroplasty Using Bone Staples

2018 ◽  
Vol 32 (09) ◽  
pp. 900-905 ◽  
Author(s):  
Kevin T. White ◽  
Andrew Fleischman ◽  
Colin T. Ackerman ◽  
Antonia F. Chen ◽  
Richard H. Rothman
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Medial Collateral Ligament ◽  
Primary Total Knee Arthroplasty ◽  
Patient Questionnaire ◽  
Primary Control ◽  
Collateral Ligament ◽  
Intraoperative Complication ◽  
Total Knee ◽  
The Mean

AbstractSuperficial medial collateral ligament (MCL) injury is an occasional intraoperative complication during total knee arthroplasty (TKA) that can lead to failure. Although previous studies have recommended complex repair or conversion to a constrained implant, the authors evaluated results of superficial distal MCL reapproximation using bone staples. Records of 31 patients who underwent staple reapproximation for superficial MCL avulsion from the tibial attachment during primary TKA from 2005 to 2015 were reviewed. They were compared with 685 patients who underwent uncomplicated TKA (primary control) and 18 who underwent revision TKA for instability (secondary control). Subjective knee instability was assessed with a patient questionnaire, and other end points included revision for instability or stiffness and manipulations under anesthesia. The authors prospectively collected Knee injury and Osteoarthritis Outcome Score (KOOS) and visual analog scale satisfaction scores. The mean follow-up was 2.6 years. No patients treated with staple repair required revision for instability, whereas two patients were revised in the primary control. Subjective instability was reported in 19.2% of staple repair patients compared with 24.2 and 46.2% of patients in the primary and secondary controls. The mean KOOS for the staple group was 71.7 points, 77.3 for the primary control, and 49.3 for the secondary. KOOSs for the staple group were 5.6 points lower than the primary control, but 22.4 points higher than the secondary. Staple reapproximation is a simple and effective method for repairing the superficial distal MCL in primary TKA. The rate of instability and functional outcomes was comparable to uncomplicated primary TKA.

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