An In Vitro Analysis of an Anatomical Medial Knee Reconstruction

Background: An anatomical medial knee reconstruction has not been described in the literature.

Hypothesis: Knee stability and ligamentous load distribution would be restored to the native state with an anatomical medial knee reconstruction.

Study Design: Controlled laboratory study.

Methods: Ten nonpaired cadaveric knees were tested in the intact, superficial medial collateral ligament and posterior oblique ligament—sectioned, and anatomically reconstructed states. Each knee was tested at 0°, 20°, 30°, 60°, and 90° of knee flexion with a 10-N·m valgus load, 5-N·m external and internal rotation torques, and 88-N anterior and posterior drawer loads. A 6 degrees of freedom electromagnetic motion tracking system measured angulation and displacement changes of the tibia with respect to the femur. Buckle transducers measured the loads on the intact and reconstructed proximal and distal divisions of the superficial medial collateral ligament and the posterior oblique ligament.

Results: A significant increase was found in valgus angulation and external rotation after sectioning the medial knee structures at all tested knee flexion angles. This was restored after an anatomical medial knee reconstruction. The authors also found a significant increase in internal rotation at 0°, 20°, 30°, and 60° of knee flexion after sectioning the medial knee structures, which was restored after the reconstruction. A significant increase in anterior translation was observed after sectioning the medial knee structures at 20°, 30°, 60°, and 90° of knee flexion. This increase in anterior translation was restored following the reconstruction at 20° and 30° of knee flexion, but was not restored at 60° and 90°. A small, but significant, increase in posterior translation was found after sectioning the medial knee structures at 0° and 30° of knee flexion, but this was not restored after the reconstruction. Overall, there were no clinically important differences in observed load on the ligaments when comparing the intact with the reconstructed states for valgus, external and internal rotation, and anterior and posterior drawer loads.

Conclusion: An anatomical medial knee reconstruction restores near-normal stability to a knee with a complete superficial medial collateral ligament and posterior oblique ligament injury, while avoiding overconstraint of the reconstructed ligament grafts.

Clinical Significance: This anatomical medial knee reconstruction technique provides native stability and ligament load distribution in patients with chronic or severe acute medial knee injuries.