scholarly journals Needle assisted arthroscopic clysis of the medial collateral ligament of the knee: a simple technique to improve exposure in arthroscopic knee surgery

2013 ◽  
Vol 5 (4) ◽  
pp. 38 ◽  
Author(s):  
Xinning Li ◽  
Ronald M. Selby ◽  
Ashley Newman ◽  
Stephen J. O'Brien
Keyword(s):  
Medial Collateral Ligament ◽  
Tibial Plateau ◽  
Medial Meniscus ◽  
Knee Arthroscopy ◽  
Medial Compartment ◽  
Spinal Needle ◽  
Collateral Ligament ◽  
Valgus Stress ◽  
Posteromedial Corner ◽  
Arthroscopic Knee

During knee arthroscopy, narrowness and tightness maybe encountered in the medial compartment that does not allow sufficient visualization or instrumentation. When this occurs, our team has found it helpful to perform a percutaneous clysis of the deep portion of the medial collateral ligament with a spinal needle. With the knee positioned in 10° to 20° of flexion and a valgus stress is applied. A spinal needle (18 Gauge) is passed percutaneously through the medial collateral ligament between the tibial plateau and undersurface of the medial meniscus. Several passes are made with the spinal needle with the bevel of the needle angled to selectively divide the fibers while keeping the medial collateral ligament under tension. Then with controlled valgus force, the medial compartment will progressively open allowing improved visualization to the posteromedial corner of the knee. This increase in space gives an enhanced visual field and further allows more room for arthroscopic instrumentation.

scholarly journals Tibial Avulsion with Intra-Articular Entrapment of Medial Collateral Ligament with Posterior Cruciate Ligament Tear with Posterior Root Medial Meniscus Tear: A Case Report of an Unusual Injury Triad

2021 ◽  
Vol 11 (8) ◽  
Author(s):  
Ishan Shevate ◽  
Girish Nathani ◽  
Ashwin Deshmukh ◽  
Anirudh Kandari
Keyword(s):  
Case Report ◽  
Medial Collateral Ligament ◽  
Medial Meniscus ◽  
Cruciate Ligament ◽  
Stress Test ◽  
Joint Line ◽  
Posterior Root ◽  
Collateral Ligament ◽  
Valgus Stress ◽  
Medial Knee

Introduction: The medial collateral ligament (MCL) is the most commonly injured ligament of the knee joint; however, its displacement into the medial knee compartment is rare. Traumatic posterior root of medial meniscus (PRMM) tears are commonly found in high-grade injuries involving anterior cruciate ligament (ACL) or posterior cruciate ligament (PCL) tears along with MCL tears. Diagnosis of these injuries can be made by a preoperative magnetic resonance imaging (MRI), but they can be missed at times due to severe soft-tissue swelling in the acute phase. Case Report: A 25-year-old gentleman presented with injury to the front of his left knee 5 days back. On examination, he had a Grade 3 effusion with valgus stress test and posterior drawer test being positive and medial joint line tenderness was present. A firm localized swelling was palpable on the medial joint line. MRI scan revealed a mid-substance PCL tear, ACL sprain, PRMM tear, and tibial side rupture of superficial MCL with proximally migrated wavy MCL fibers lying below the medial meniscus confirmed on arthroscopy. Medial meniscus root repair by pull through technique and PCL reconstruction with a 3-strand peroneus longus graft followed by open MCL repair with augmentation using a semitendinosus graft was performed. Postoperatively, the knee was kept in a straight knee brace for 4 weeks, followed by a hinged knee brace and appropriate physiotherapy were started. At 2 years follow-up, the patient had attained full range of knee motion with good quadriceps strength, tibial step off maintained, and negative posterior drawer test and valgus stress test. Displacement of torn MCL into the medial knee compartment is an extremely rare injury. Proximal or distal avulsion of MCL with intra-articular incarceration has been reported in isolation or associated with ACL tear. Such an injury triad as reported here has not been reported in the literature to the best of our review. Conclusion: In our case, we report a ver

scholarly journals Medial collateral ligament release during knee arthroscopy: key concepts

2021 ◽  
Vol 6 (8) ◽  
pp. 669-675
Author(s):  
Vicente Carlos da Silva Campos ◽  
Francisco Guerra Pinto ◽  
Diogo Constantino ◽  
Renato Andrade ◽  
João Espregueira-Mendes
Keyword(s):  
Medial Meniscus ◽  
Knee Arthroscopy ◽  
Cartilage Damage ◽  
Joint Space ◽  
Medial Compartment ◽  
Collateral Ligament ◽  
Tibiofemoral Joint ◽  
Key Concepts ◽  
Complete Access ◽  
Inside Out

Complete access to the posterior medial compartment of the knee may represent a technical challenge during arthroscopy in patients with a tight tibiofemoral joint space. Medial collateral release reduces direct iatrogenic cartilage damage in the medial compartment of the knee through manipulation with instruments. We recommend performing medial collateral release in surgeries that access the posteromedial compartment (e.g. partial meniscectomy for ruptures of the posterior horn of medial meniscus or posterior root repairs) when the patient has a tight tibiofemoral joint space. There are two main techniques to perform medial collateral release: inside-out and outside-in. Regardless of the technique used, releasing medial ligament structures is a safe and effective method to be used in the diagnosis and treatment of injuries to the medial compartment. Cite this article: EFORT Open Rev 2021;6:669-675. DOI: 10.1302/2058-5241.6.200128

The Effectiveness of a Hinged Elbow Orthosis in Medial Collateral Ligament Injuries: An In Vitro Biomechanical Study

2019 ◽  
Vol 47 (12) ◽  
pp. 2827-2835
Author(s):  
Ranita H.K. Manocha ◽  
James A. Johnson ◽  
Graham J.W. King
Keyword(s):  
Medial Collateral Ligament ◽  
Muscle Activation ◽  
Mechanical Stability ◽  
Biomechanical Study ◽  
Return To Play ◽  
Collateral Ligament ◽  
Valgus Stress ◽  
Active Motion ◽  
Early Return

Background: Medial collateral ligament (MCL) injuries are common after elbow trauma and in overhead throwing athletes. A hinged elbow orthosis (HEO) is often used to protect the elbow from valgus stress early after injury and during early return to play. However, there is minimal evidence regarding the efficacy of these orthoses in controlling instability and their influence on long-term clinical outcomes. Purpose: (1) To quantify the effect of an HEO on elbow stability after simulated MCL injury. (2) To determine whether arm position, forearm rotation, and muscle activation influence the effectiveness of an HEO. Study Design: Controlled laboratory study. Methods: Seven cadaveric upper extremity specimens were tested in a custom simulator that enabled elbow motion via computer-controlled actuators and motors attached to relevant tendons. Specimens were examined in 2 arm positions (dependent, valgus) and 2 forearm positions (pronation, supination) during passive and simulated active elbow flexion while unbraced and then while braced with an HEO. Testing was performed in intact elbows and repeated after simulated MCL injury. An electromagnetic tracking device measured valgus angulation as an indicator of elbow stability. Results: When the arm was dependent, the HEO increased valgus angle with the forearm in pronation (+1.0°± 0.2°, P = .003) and supination (+1.5°± 0.0°, P = .006) during active motion. It had no significant effect on elbow stability during passive motion. In the valgus position, the HEO had no effect on elbow stability during passive or active motion in pronation and supination. With the arm in the valgus position with the HEO, muscle activation reduced instability during pronation (–10.3°± 2.5°, P = .006) but not supination ( P = .61). Conclusion: In this in vitro study, this HEO did not enhance mechanical stability when the arm was in the valgus and dependent positions after MCL injury. Clinical Relevance: After MCL injury, an HEO likely does not provide mechanical elbow stability during rehabilitative exercises or when the elbow is subjected to valgus stress such as occurs during throwing.

scholarly journals Open Anatomic Reconstruction of the Medial Collateral Ligament and Posteromedial Corner

2015 ◽  
Vol 4 (6) ◽  
pp. e885-e890 ◽  
Author(s):  
Matthew R. Prince ◽  
Andrew J. Blackman ◽  
Alexander H. King ◽  
Michael J. Stuart ◽  
Bruce A. Levy
Keyword(s):  
Medial Collateral Ligament ◽  
Anatomic Reconstruction ◽  
Collateral Ligament ◽  
Posteromedial Corner
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