SEMITENDINOUS AND GRACILIS TRANSFER FOR TREATMENT OF MEDIAL COLLATERAL LIGAMENT INJURY CAUSED BY TOTAL KNEE ARTHROPLASTY_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

CAOJiangang , WANGLei , ZHAOHuiwen ,  LIUJun

Department of Joint Surgery, Tianjin Hospital, Tianjin, 300222, P. R. China;

Corresponding author：

LIUJun, Email: drliujun@hotmail.com

Keywords：

Total knee arthroplasty; Medial collateral ligament injury; Ligament repair; Semitendinous tendon; Gracilis

DOI：

10.7507/1002-1892.20160030

Video：

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Objective To evaluate the effectiveness of semitendinous and gracilis transfer for the treatment of medial collateral ligament (MCL) injury caused by total knee arthroplasty (TKA). Methods Between March 2009 and May 2014, 11 patients (11 knees) with MCL injuries caused by primary TKA were treated by semitendinous and gracilis transfer in primary TKA (injury group). Another 18 patients (21 knees) without MCL injury were included as the control group. There was no significant difference in gender, age, injury sides, disease duration, body mass index, knee varus deformity, and preoperative Knee Society Score (KSS) between 2 groups (P>0.05), with comparability. KSS score was used to evaluate the function after operation. Results Primary healing of incision was obtained in all patients, and no complications of joint instability and pain occurred. The follow-up time was 6-29 months in injury group and was 7-34 months in control group. At last follow-up, the KSS clinical score and functional score were significantly increased to 89.82±3.76 and 89.54±3.50 in the injury group (P<0.05) and were significantly increased to 90.19±3.39 and 90.00±3.53 in the control group (P<0.05) respectively, but no significant difference was shown between 2 groups (t=0.158, P=0.877; t=0.820, P=0.432). X-ray films showed no prosthetic loosening or subsidence during follow-up. Conclusion The semitendinous and gracilis transfer is reliable for the treatment of MCL injury caused by TKA. The insertions of semitendinous tendon and gracilis are close to that of the knee MCL, which can effectively improve knee function.

Citation： CAOJiangang, WANGLei, ZHAOHuiwen, LIUJun. SEMITENDINOUS AND GRACILIS TRANSFER FOR TREATMENT OF MEDIAL COLLATERAL LIGAMENT INJURY CAUSED BY TOTAL KNEE ARTHROPLASTY. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(2): 148-151. doi: 10.7507/1002-1892.20160030 Copy

1.	Naudie DD, Rorabeck CH. Managing instability in total knee arthroplasty with constrained and linked implants. Instr Course Lect, 2004, 53:207-215.
2.	Whiteside LA. Correction of ligament and bone defects in total knee arthroplasty of the severely valgus knee. Clin Orthop Relat Res, 1993, (288):234-245.
3.	Chang MJ, Lim H, Lee NR, et al. Diagnosis, causes and treatments of instability following total knee arthroplasty. Knee Surg Relat Res, 2014, 26(2):61-67.
4.	Leopold SS, McStay C, Klafeta K, et al. Primary repair of intraoperative disruption of the medical collateral ligament during total knee arthroplasty. J Bone Joint Surg (Am), 2001, 83-A(1):86-91.
5.	Le DH, Goodman SB, Maloney WJ, et al. Current modes of failure in TKA:infection, instability, and stiffness predominate. Clin Orthop Relat Res, 2014, 472(7):2197-2200.
6.	Lee GC, Lotke PA. Management of intraoperative medial collateral ligament injury during TKA. Clin Orthop Relat Res, 2011, 469(1):64-68.
7.	Iizawa N, Mori A, Majima T, et al. Influence of the medial knee structures on valgus and rotatory stability in total knee arthroplasty. J Arthroplasty, 2015.[Epub ahead of print].
8.	Athwal KK, Daou HE, Kittl C, et al. The superficial medial collateral ligament is the primary medial restraint to knee laxity after cruciate-retaining or posterior-stabilised total knee arthroplasty:effects of implant type and partial release. Knee Surg Sports Traumatol Arthrosc, 2015.[Epub ahead of print].
9.	Jung KA, Lee SC, Hwang SH, et al. Quadriceps tendon free graft augmentation for a midsubstance tear of the medial collateral ligament during total knee arthroplasty. Knee, 2009, 16(6):479-483.
10.	Siqueira MB, Haller K, Mulder A, et al. Outcomes of medial collateral ligament injuries during total knee arthroplasty. J Knee Surg, 2016, 29(1):68-73.
11.	Koo MH, Choi CH. Conservative treatment for the intraoperative detachment of medial collateral ligament from the tibial attachment site during primary total knee arthroplasty. J Arthoplasty, 2009, 24(8):1249-1253.
12.	Vasso M, Beaufils P, Schiavone Panni A. Constraint choice in revision knee arthroplasty. Int Orthop, 2013, 37(7):1279-1284.
13.	Peter CL, Dienst M, Erickson J. Reconstruction of the medial femoral condyle and medial collateral ligament in total knee arthroplasty using tendoachilles allograft with a calcaneal bone block. J Arthoplasty, 2004, 19(7):935-940.
14.	DeLong JM, Waterman BR. Surgical techniques for the reconstruction of medial collateral ligament and posteromedial corner injuries of the knee:A systematic review. Arthroscopy, 2015, 31(11):2258-2272. e1.
15.	Deo S, Getgood A. A technique of superficial nedial collateral ligament reconstruction using an adjustable-Loop Suspensory Fixation Device. Arthrosc Tech, 2015, 4(3):e261-265.
16.	Omar M, Petri M, Dratzidis A, et al. Biomechanical comparison of fixation techniques for medial collateral ligament anatomical augmented repair. Knee Surg Sports Traumatol Arthrosc, 2014.[Epub ahead of print].
17.	Forkel P, Seppel G, Imhoff A, et al. Suturing and refixation of the medial collateral ligament in severe acute medial instability of the knee. Oper Orthop Traumatol, 2015, 27(2):155-171.
18.	Heller KD. Intraoperative damage to the medial collateral ligament (MCL)-what is to be done? Z Orthop Unfall, 2013, 151(6):580-584.

1. Naudie DD, Rorabeck CH. Managing instability in total knee arthroplasty with constrained and linked implants. Instr Course Lect, 2004, 53:207-215.
2. Whiteside LA. Correction of ligament and bone defects in total knee arthroplasty of the severely valgus knee. Clin Orthop Relat Res, 1993, (288):234-245.
3. Chang MJ, Lim H, Lee NR, et al. Diagnosis, causes and treatments of instability following total knee arthroplasty. Knee Surg Relat Res, 2014, 26(2):61-67.
4. Leopold SS, McStay C, Klafeta K, et al. Primary repair of intraoperative disruption of the medical collateral ligament during total knee arthroplasty. J Bone Joint Surg (Am), 2001, 83-A(1):86-91.
5. Le DH, Goodman SB, Maloney WJ, et al. Current modes of failure in TKA:infection, instability, and stiffness predominate. Clin Orthop Relat Res, 2014, 472(7):2197-2200.
6. Lee GC, Lotke PA. Management of intraoperative medial collateral ligament injury during TKA. Clin Orthop Relat Res, 2011, 469(1):64-68.
7. Iizawa N, Mori A, Majima T, et al. Influence of the medial knee structures on valgus and rotatory stability in total knee arthroplasty. J Arthroplasty, 2015.[Epub ahead of print].
8. Athwal KK, Daou HE, Kittl C, et al. The superficial medial collateral ligament is the primary medial restraint to knee laxity after cruciate-retaining or posterior-stabilised total knee arthroplasty:effects of implant type and partial release. Knee Surg Sports Traumatol Arthrosc, 2015.[Epub ahead of print].
9. Jung KA, Lee SC, Hwang SH, et al. Quadriceps tendon free graft augmentation for a midsubstance tear of the medial collateral ligament during total knee arthroplasty. Knee, 2009, 16(6):479-483.
10. Siqueira MB, Haller K, Mulder A, et al. Outcomes of medial collateral ligament injuries during total knee arthroplasty. J Knee Surg, 2016, 29(1):68-73.
11. Koo MH, Choi CH. Conservative treatment for the intraoperative detachment of medial collateral ligament from the tibial attachment site during primary total knee arthroplasty. J Arthoplasty, 2009, 24(8):1249-1253.
12. Vasso M, Beaufils P, Schiavone Panni A. Constraint choice in revision knee arthroplasty. Int Orthop, 2013, 37(7):1279-1284.
13. Peter CL, Dienst M, Erickson J. Reconstruction of the medial femoral condyle and medial collateral ligament in total knee arthroplasty using tendoachilles allograft with a calcaneal bone block. J Arthoplasty, 2004, 19(7):935-940.
14. DeLong JM, Waterman BR. Surgical techniques for the reconstruction of medial collateral ligament and posteromedial corner injuries of the knee:A systematic review. Arthroscopy, 2015, 31(11):2258-2272. e1.
15. Deo S, Getgood A. A technique of superficial nedial collateral ligament reconstruction using an adjustable-Loop Suspensory Fixation Device. Arthrosc Tech, 2015, 4(3):e261-265.
16. Omar M, Petri M, Dratzidis A, et al. Biomechanical comparison of fixation techniques for medial collateral ligament anatomical augmented repair. Knee Surg Sports Traumatol Arthrosc, 2014.[Epub ahead of print].
17. Forkel P, Seppel G, Imhoff A, et al. Suturing and refixation of the medial collateral ligament in severe acute medial instability of the knee. Oper Orthop Traumatol, 2015, 27(2):155-171.
18. Heller KD. Intraoperative damage to the medial collateral ligament (MCL)-what is to be done? Z Orthop Unfall, 2013, 151(6):580-584.

Chinese Journal of Reparative and Reconstructive Surgery

SEMITENDINOUS AND GRACILIS TRANSFER FOR TREATMENT OF MEDIAL COLLATERAL LIGAMENT INJURY CAUSED BY TOTAL KNEE ARTHROPLASTY

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