Reconstruction of the Medial Collateral Ligament for the Medial Instability after Primary Total Knee Arthroplasty - A Case Report -

Chul-Won Ha; Chan-Ha Hwang; Kyung-Sub Lim

doi:10.4055/jkoa.2007.42.3.395

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Ha, Hwang, and Lim: Reconstruction of the Medial Collateral Ligament for the Medial Instability after Primary Total Knee Arthroplasty - A Case Report -

Case Report

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2007; 42(3): 395-399.

Published online: 30 June 2007

DOI: https://doi.org/10.4055/jkoa.2007.42.3.395

Reconstruction of the Medial Collateral Ligament for the Medial Instability after Primary Total Knee Arthroplasty - A Case Report -

Chul-Won Ha, M.D., Chan-Ha Hwang, M.D.^*, Kyung-Sub Lim, M.D.

Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

^*Department of Orthopedic Surgery, Cheong-Ju St. Mary's Hospital, Cheongju, Korea.

Address reprint requests to Chul-Won Ha, M.D. Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, Ilwon-dong, Gangnam-gu, Seoul 135-710, Korea. TEL: +82.2-3410-0275, FAX: +82.2-3410-0061, hacw@smc.samsung.co.kr

Abstract

An absence or compromise of the medial collateral ligament that occurs after primary total knee arthroplasty is a challenging reconstructive problem. Treatment usually requires unlinked-constrained total knee arthroplasty. Revision with unlinked-constrained prostheses often causes more bone loss and transmits increased stress to the bone-cement and prosthesis-cement interfaces, which can increase the risk of aseptic loosening. However, there are no treatment options other than constrained prostheses. We present a 47-year-old female who suffered from medial instability that occurred after total knee arthroplasty, which was treated successfully by a medial collateral ligament reconstruction.

Keywords: Knee medial instability, Medial collateral ligament reconstruction, Total knee arthroplasty

Figures and Tables

Fig. 1

Preoperative valgus stress view of both knees. Radiographs showed medial instability of the left knee with valgus stress at full extension (A) and at 30° flexion (B).

Fig. 2

(A) Intraoperative finding showed a loss of medial collateral ligament at femoral at the tachment site. (B) Intraoperative mild valgus stress provokes abnormal widening of the medial joint space without resistance.

Fig. 3

(A) The femoral tunnel (diameter 10 mm and depth 20 mm) was made at the medial femoral condyle. (B) A 10 mm diameter tibial tunnel, which was made anterior to the posterior direction at the medial proximal tibia. (C) A bone block graft was inserted into the femoral tunnel. (D) Two tendinous bundles were inserted into the tibial tunnel. One bundle was passed from the anterior to the posterior direction and the other bundle was passed from the posterior to the anterior direction. Each bundle was then sutured over the other bundle.

Fig. 4

Postoperative valgus stress view of both knees. The medial instability of the left knee had disappeared with valgus stress at full extension (A) and at 30° flexion (B).

Fig. 5

Postoperative valgus stress view of both knees at two years after surgery. The radiographs show no medial joint space opening on standing.

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