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Single-bundle MCL reconstruction with anatomic single-bundle ACL reconstruction does not restore knee kinematics

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of this study was to evaluate and compare knee kinematics and kinetics following either single bundle, modified triangular or double-bundle reconstruction of the superficial medial collateral ligament (sMCL) with single bundle anatomic ACL reconstruction.

Methods

Using a cadaveric model (n = 10), the knee kinematics and kinetics following three MCL reconstructions (single-bundle (SB), double-bundle (DB), modified triangular) with single bundle anatomic ACL reconstruction were compared with the intact and deficient knee state. The knees were tested under (1) an 89-N anterior tibial load, (2) 5 N-m internal and external rotational tibial torques, and (3) a 7 N-m valgus torque.

Results

Anatomic ACL reconstruction with SB MCL reconstruction was able to restore anterior tibial translation and external rotation to intact knee values but failed to the internal and valgus rotatory stability. Anatomical DB MCL reconstruction (with SB ACL reconstruction) and the modified triangular MCL reconstruction (with SB ACL reconstruction) restored all knee kinematics to the intact value.

Conclusion

This study shows that clinical presentation with combined ACL and severe sMCL injury, single-bundle MCL with single-bundle ACL reconstruction does not restore knee kinematics. Anatomical double-bundle MCL reconstruction may produce slightly better biomechanical stability than the modified triangular MCL reconstruction, but the modified triangular reconstruction might be more clinically practical with the advantages of being less invasive and technically simpler while at the same time can restore a nearly normal knee joint.

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Funding

Department of Orthopedics.

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Author notes

  1. Weimin Zhu and Junjun Zhu have contributed equally to this work.

Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, 3471 Fifth Avenue, Suite 1010, Kaufmann Building, Pittsburgh, PA, 15213, USA

    Weimin Zhu, Monica A. Linde, Patrick Smolinski & Freddie H. Fu

  2. Shenzhen 2nd People’s Hospital (The First Affiliated Hospital of Shenzhen University), Guangdong, China

    Weimin Zhu

  3. Department of Mechanical Engineering and Material Science, University of Pittsburgh, Pittsburgh, PA, USA

    Junjun Zhu, Brandon Marshall, Patrick Smolinski & Freddie H. Fu

Authors
  1. Weimin Zhu
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  2. Junjun Zhu
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  3. Brandon Marshall
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  4. Monica A. Linde
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  5. Patrick Smolinski
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  6. Freddie H. Fu
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Contributions

All authors contributed to the preparation of this work. JZ and WZ contributed equally to the design and implementation of the research.

Corresponding author

Correspondence to Freddie H. Fu.

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Conflict of interest

Weimin Zhu, MD, PhD, Junjun Zhu, PhD, Brandon Marshall, MS, Monica Linde, MS, Patrick Smolinski, PhD, and Freddie H. Fu, MD have no conflict of interest.

Ethical approval

Approval for this study and use of cadaver specimens was obtained from the University of Pittsburgh Committee for Oversight of Research and Clinical Training Involving Decedents (CORID).

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Zhu, W., Zhu, J., Marshall, B. et al. Single-bundle MCL reconstruction with anatomic single-bundle ACL reconstruction does not restore knee kinematics. Knee Surg Sports Traumatol Arthrosc 28, 2687–2696 (2020). https://doi.org/10.1007/s00167-020-05934-5

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  • DOI: https://doi.org/10.1007/s00167-020-05934-5

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