title: The superficial medial collateral ligament reconstruction of the knee: effect of altering graft length on knee kinematics and stability.
abstract: OBJECTIVE
  The purpose of this study was to evaluate and compare the resulting knee kinematics and stability of an anatomic superficial MCL (sMCL) reconstruction and a non-anatomic sMCL reconstruction.
  
  
  METHODS
  In a cadaveric model, normal knee stability and kinematics were compared with sMCL deficient knees and with two experimental sMCL reconstructions. The first reconstruction (AnatRecon) attempted to anatomically reconstruct the sMCL. The second reconstruction (ShortRecon) used a shorter graft to mimic the effect of failing to reproduce the anatomic length of the sMCL. Changes in position of the femur with respect to the tibia were measured with an electromagnetic tracking system during simulated active knee extension and during passive knee stability testing in the sMCL intact knee, the sMCL deficient knee, and the two experimental reconstructions.
  
  
  RESULTS
  Simulated active knee extension demonstrated a significant increase in external tibial rotation of ShortRecon compared to AnatRecon between 30° and 80° of knee flexion (mean difference <3.0° over the range of knee flexion angles; P < 0.008), and a significant increase in external tibial rotation of ShortRecon compared to the intact sMCL was found at 60° and 70° of knee flexion (mean difference <2.0°over the range of knee flexion angles; P < 0.008). Passive joint stability testing demonstrated that division of the sMCL produced approximately 6° of valgus laxity at 30° of knee flexion and increased external tibial rotation of approximately 5° at 30°, 9° at 60°, and 10° at 90° of knee flexion, respectively. AnatRecon restored normal knee kinematics and stability. Additionally, passive stability testing demonstrated a significant increase in external tibial rotation of ShortRecon compared to AnatRecon at 60° (mean difference = 3.7°; P < 0.05) and 90° of knee flexion (mean difference = 4.9°; P < 0.05).
  
  
  CONCLUSIONS
  Anatomic reconstruction of the sMCL effectively restored knee kinematics and stability in the sMCL deficient knee. Altering the normal ligament length resulted in measurable changes in knee kinematics and stability. This study suggests that in cases of chronic valgus knee instability, anatomic sMCL reconstruction would provide better results than non-anatomic sMCL reconstruction.
authors.affiliation: Department of Orthopedic Surgery, University of California at Davis, School of Medicine, Sacramento, CA, USA. james.vandenbogaerde@ucdmc.ucdavis.edu
authors.forename: J M
authors.initials: JM
authors.lastname: Van den Bogaerde
authors.forename: E
authors.initials: E
authors.lastname: Shin
authors.forename: C P
authors.initials: CP
authors.lastname: Neu
authors.forename: R A
authors.initials: RA
authors.lastname: Marder
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D001696:Biomechanical Phenomena; D002102:Cadaver; D055590:Electromagnetic Phenomena; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology / Q000601:surgery*; D017888:Medial Collateral Ligament, Knee / Q000503:physiopathology / Q000601:surgery*; D008875:Middle Aged; D016059:Range of Motion, Articular / Q000502:physiology; D019651:Plastic Surgery Procedures / Q000379:methods*; D012399:Rotation; D013977:Tibia / Q000503:physiopathology; D016896:Treatment Outcome