Abstract
Introduction: The relationship between the axial alignment of the knee and symptomatic instability of the collateral ligament is very important. This paper presents an approach to the management of chronic collateral ligament instability. Reconstruction of the MCL in the valgus knee and of the LCL in the varus knee is usually unsuccessful without re-alignment of the knee.
Method: The gait pattern of the patient with valgus alignment and MCL laxity demonstrates a medial thrust on weight-bearing. Laxity may involve the MCL alone, in combination with ACL laxity, or associated with LCL laxity. MCL laxity in the valgus knee is best managed with a varus distal femoral osteotomy. MCL laxity with medial osteoarthritis is best managed with an open wedge valgus tibial osteotomy.
LCL laxity in the varus knee responds well to valgus correction with a high tibial osteotomy. LCL laxity secondary to malunion of a lateral tibial plateau fracture can be managed with an open wedge varus high tibial osteotomy
Results: Fifty-two patients with chronic, symptomatic collateral ligament instability have been surgically reconstructed. Most cases involved multiple ligament injury and most were seen after the initial surgical procedure. Twenty-eight of 52 patients underwent two or more operative procedures before osteotomy. Twenty-one cases involved the MCL and 3l involved the LCL.
Varus distal femoral osteotomy was performed for isolated symptomatic MCL laxity. The average resultant anatomical axis was zero degrees. This resulted in loss of the medial thrust on weightbearing. Patients with injuries resulting in early medial OA with varus alignment and MCL laxity were treated with open wedge valgus high tibial osteotomy.
The majority of patients with LCL laxity and varus alignment responded to closing wedge valgus high tibial osteotomy. A smaller number (six) with depression of the lateral tibial plateau two degrees to fracture and associated LCL laxity responded to open wedge varus high tibial osteotomy.
ACL patients were followed for over two years (range two to four years) post-surgery. All patients were assessed clinically and radiographically. Clinical examinations included a Lysholm functional score and Tegner activity scale. Radiographic examination included pre- and post-operative three foot x-rays and pre-operation valgus, varus stem x-rays.
These abstracts were prepared by Editorial Secretary, George Sikorski. Correspondence should be addressed to Australian Orthopaedic Association, Ground Floor, The William Bland Centre, 229 Macquarie Street, Sydney, NSW 2000, Australia.
At least one of the authors is receiving or has received material benefits or support from a commercial source.
