Collateral ligament strain is linearly related to coronal lower limb alignment: A biomechanical study.

Autor: Peez C; Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany., Hägerich LM; Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany., Ruhl F; Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany., Klimek M; Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany., Briese T; Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany., Glasbrenner J; Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany., Deichsel A; Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany., Raschke MJ; Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany., Kittl C; Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany., Herbst E; Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany.
Jazyk: angličtina
Zdroj: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA [Knee Surg Sports Traumatol Arthrosc] 2024 Jun 27. Date of Electronic Publication: 2024 Jun 27.
DOI: 10.1002/ksa.12340
Abstrakt: Purpose: The purpose of this study was to analyse the influence of coronal lower limb alignment on collateral ligament strain.
Methods: Twelve fresh-frozen human cadaveric knees were used. Long-leg standing radiographs were obtained to assess lower limb alignment. Specimens were axially loaded in a custom-made kinematics rig with 200 and 400 N, and dynamic varus/valgus angulation was simulated in 0°, 30°, and 60° of knee flexion. The changes in varus/valgus angulation and strain within different fibre regions of the collateral ligaments were captured using a three-dimensional optical measuring system to examine the axis-dependent strain behaviour of the superficial medial collateral ligament (sMCL) and lateral collateral ligament (LCL) at intervals of 2°.
Results: The LCL and sMCL were exposed to the highest strain values at full extension (p < 0.001). Regardless of flexion angle and extent of axial loading, the ligament strain showed a strong and linear association with varus (all Pearson's r ≥ 0.98; p < 0.001) and valgus angulation (all Pearson's r ≥ -0.97; p < 0.01). At full extension and 400 N of axial loading, the anterior and posterior LCL fibres exceeded 4% ligament strain at 3.9° and 4.0° of varus, while the sMCL showed corresponding strain values of more than 4% at a valgus angle of 6.8°, 5.4° and 4.9° for its anterior, middle and posterior fibres, respectively.
Conclusion: The strain within the native LCL and sMCL was linearly related to coronal lower limb alignment. Strain levels associated with potential ultrastructural damages to the ligaments of more than 4% were observed at 4° of varus and about 5° of valgus malalignment, respectively. When reconstructing the collateral ligaments, an additional realigning osteotomy should be considered in cases of chronic instability with a coronal malalignment exceeding 4°-5° to protect the graft and potentially reduce failures.
Level of Evidence: There is no level of evidence as this study was an experimental laboratory study.
(© 2024 The Author(s). Knee Surgery, Sports Traumatology, Arthroscopy published by John Wiley & Sons Ltd on behalf of European Society of Sports Traumatology, Knee Surgery and Arthroscopy.)
Databáze: MEDLINE
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