Double-row repair of the distal attachment of the superficial medial collateral ligament: a basic science pilot study.
OBJECTIVE
To describe a novel repair for tibial-sided superficial medial collateral ligament (sMCL) lesions and determine whether it restores medial joint opening to uninjured state. Agreement among experienced knee surgeons when evaluating medial joint laxity was also explored.


METHODS
On a series of eight human cadaveric knees, surgical elevation of the distal insertion of the sMCL was performed to replicate injury. The cut ligament was repaired using a novel double-row 'suture-bridge' technique. Valgus stress fluoroscopic images were taken with the ligament in three states: (I)ntact, (C)ut and (R)epaired, in two positions: 0 and 20° flexion. Joint opening was measured on calibrated fluoroscopic images (in mm) based on methods described by LaPrade. Joint space opening was also estimated by three experienced knee surgeons without fluoroscopy.


RESULTS
On fluoroscopy, no significant differences in mean joint opening were observed between an intact versus repaired ligament in 0 and 20° flexion [0.5 mm (95 % CI -1.6, 0.73; n.s.) and 0.3 mm (95 % CI -1.17, 1.71; n.s.)], respectively. Agreement among surgeons was substantial (ICC = 0.622, 95 % CI 0.52, 0.73).


CONCLUSIONS
The surgical technique adequately restored joint opening to an intact state with response to valgus stress. Agreement among surgeons when quantifying joint opening in mm was substantial. This paper addresses a technically difficult problem and provides pragmatic and practical information for surgeons who manage complicated multi-ligament knee injuries.
University of Toronto, Toronto, ON, Canada. wheland@smh.toronto.on.ca.
Daniel
D
Whelan
Pan Am Clinic, University of Manitoba, Winnipeg, MN, Canada.
Jeff
J
Leiter
Sasyniuk Consulting, Vancouver, BC, Canada. sasyniuk@gmail.com.
Treny
T
Sasyniuk
Fowler Kennedy Clinic, University of Western Ontario, London, ON, Canada.
Robert
R
Litchfield
Southlake Regional Hospital, Newmarket, ON, Canada.
John
J
Randle
Pan Am Clinic, University of Manitoba, Winnipeg, MN, Canada.
Scott
S
Hughes
Pan Am Clinic, University of Manitoba, Winnipeg, MN, Canada.
Peter
P
MacDonald
D002102:Cadaver; D005471:Fluoroscopy; D006801:Humans; D017888:Medial Collateral Ligament, Knee / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D010865:Pilot Projects; D016059:Range of Motion, Articular; D013536:Suture Techniques
Cadaveric; Double-row suture-bridge repair; Stress fluoroscopy; Superficial medial collateral ligament