Background: Anteromedial rotatory instability (AMRI) can result from combined injury to the anterior cruciate ligament (ACL) and medial collateral ligament (MCL) complex (superficial and deep [sMCL and dMCL]). Hypothesis: Adding an oblique anteromedial (AM) limb to an sMCL reconstruction improves the control of AMRI. Study Design: Controlled laboratory study. Methods: A 6 degrees of freedom robotic setup simulated clinical laxity in 9 unpaired knees under the following tests: 5-N·m external rotation (ER), 8-N·m valgus rotation (VR), and AM drawer (combined 89-N anterior tibial translation and 5-N·m ER). Knees were tested intact after cutting the sMCL and dMCL and after 5 different reconstructions: modified Lind, short sMCL, and sMCL with the addition of an AM graft limb with 3 different obliquities. Results: After short sMCL reconstruction, AM drawer and ER laxity were not significantly different from either the MCL-deficient state or the intact state. VR was reduced from the MCL-deficient state between 0° and 60° of flexion but not at 90°. For combined sMCL + AM reconstructions, VR was reduced as compared with the MCL-deficient state at all flexion angles. AM drawer laxity and ER laxity were also reduced, similar to the intact state, except at 30° where, for the more oblique T1 and T2 AM reconstructions, laxity was less than in the intact state. The modified Lind reconstruction reduced AM drawer and ER laxity from the MCL-deficient state to values similar to the intact state at all flexion angles. VR laxity was also reduced at all flexion angles, similar to the intact knee at 0° to 30°. However, it was not as good at restraining AM drawer and ER when compared with the sMCL reconstructions with more oblique AM limbs. Conclusion: AMRI appears to be better restrained by adding an oblique AM graft limb to an sMCL reconstruction, replicating the function of the sMCL and dMCL in a cadaveric model. The tibial attachment of the AM limb should be anterior to the sMCL, but its precise attachment on the tibia is less important. This offers surgical flexibility, which may be helpful in avoiding anterior cruciate ligament tibial tunnel coalition. The femoral attachment on the posterior medial epicondyle is critical to optimize graft isometry. Clinical Relevance: Adding an AM limb to a medial reconstruction optimizes the control of AMRI at time zero. The tibial attachment site is less critical, offering surgical flexibility.

中文翻译：

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优化前内侧旋转膝关节不稳定性的控制：不同前内侧重建技术的生物力学验证


背景：前交叉韧带 （ACL） 和内侧副韧带 （MCL） 复合体 （浅深 [sMCL 和 dMCL]）联合损伤可导致前前交叉韧带 （AMRI）。假设： 在 sMCL 重建中增加斜前内侧 （AM） 肢体可以改善对 AMRI 的控制。研究设计： 对照实验室研究。方法：在以下测试下，6 自由度机器人设置模拟 9 个未配对膝关节的临床松弛：5-N·m 外旋 （ER）、8-N·m 外翻旋转 （VR） 和 AM 抽屉 （结合 89-N 胫骨前平移和 5-N·m ER）。在切割 sMCL 和 dMCL 后以及经过 5 种不同的重建后，对膝关节进行了完整的测试：改良的 Lind、短 sMCL 和 sMCL，并增加了具有 3 种不同斜度的 AM 移植肢体。结果： 短 sMCL 重建后，AM 抽屉和 ER 松弛与 MCL 缺陷状态或完整状态无显著差异。VR 在屈曲 0° 至 60° 之间从 MCL 缺陷状态降低，但在 90° 时没有降低。对于 sMCL + AM 联合重建，在所有屈曲角度下，与 MCL 缺陷状态相比，VR 均降低。AM 抽屉松弛度和 ER 松弛度也降低，与完整状态相似，除了在 30° 时，对于更倾斜的 T1 和 T2 AM 重建，松弛度小于完整状态。改良的 Lind 重建将 MCL 缺陷状态的 AM 抽屉和 ER 松弛度降低到与所有屈曲角度下的完整状态相似的值。VR 松弛在所有屈曲角度下也均有所减少，与 0° 至 30° 时的完整膝关节相似。然而，与具有更倾斜的 AM 肢体的 sMCL 重建相比，它在抑制 AM 抽屉和 ER 方面不如好。 结论： 通过在 sMCL 重建中增加斜 AM 移植肢体，在尸体模型中复制 sMCL 和 dMCL 的功能，AMRI 似乎得到了更好的抑制。AM 肢体的胫骨附着应在 sMCL 的前面，但它在胫骨上的精确附着不太重要。这提供了手术灵活性，可能有助于避免前交叉韧带胫管联合。后内上髁上的股骨附着对于优化移植物等距测量至关重要。临床相关性： 在内侧重建中增加 AM 肢体可优化时间零时 AMRI 的控制。胫骨附着部位不太重要，可提供手术灵活性。