Risk of Medial Collateral Ligament Injury in Knee Arthroplasty

Medial Collateral Ligament Injury

Oscillating surgical saw blades are used for bone shaping in total knee arthroplasty. In order to facilitate these cutting procedures, cutting guides have been designed for all implant systems. These guides show which area to cut and at what angle. However, it cannot completely prevent the blade from deviation in medial-lateral (inside-outside) direction. (K. Dimitris et al., 2010) In this article, we’ll try to explain to you what causes to Medial Collateral Ligament Injury?

Prevalence and Effects of Medial Collateral Ligament Injury

Intraoperative injury to the medial collateral ligament (internal lateral ligament) is a known complication of total knee arthroplasty. The prevalence of this complication is changing from 2.7% to 8%. (K. Dimitris et al., 2010; Seth S. Leopold et al., 2001) Although the rate of this accidental injury seems low, it is very important for the proper functioning and longevity of the implant. Loss of the inner lateral ligament can lead to the failure of knee arthroplasty by causing instability. (Xiaomeng Wang et al., 2017) Therefore, surgical treatment of the internal lateral ligament may be necessary in such an injury. This damage can cause longer recovery time and more pain for the patient as well as the prolongation of the operation time. (K. Dimitris et al., 2010)

In the study conducted by Seth S. Leopold et al in 2001, primary knee arthroplasty operations between 1991 and 1997 were examined. In 600 knees, 16 (2.7%) medial collateral ligament injuries were detected. All of these injuries are thought to be caused by retractors, saw blade oscillation, or other cutting tools.

In the study by Xiaomeng Wang et al in 2017, 2037 knee arthroplasty were examined between 2007 and 2013, and 12 of them were identified as medial collateral ligament injuries. Again, the whole ligament injury is caused by saw blades or other cutting tools.

Comparison of Two Oscillating Saw Blades Widths In Terms Of Deviation Rates

K. Dimitris et al compared the deviations of two different widths of saw blades in the medial and lateral cuts in a study they conducted with 50 women and 50 men in 2010. Blade widths are 12.5mm (narrow) and 19.5mm (wide). Both blade thicknesses are 1.19 mm. In experiments, it has been shown that the wide blade exceeds the posterior femoral condyle cuts in women and the posterior lateral femoral condyle cut in men. These results demonstrate the potential of the saw blade to damage nearby structures, including the medial collateral ligament.

Click here to learn how to choose a surgical saw blade.

Evaluation - Medial Collateral Ligament Injury

Besides the blade width, attention should be paid to the oscillation angle of the surgical power tools. It is known that cutting performance increases with increasing surgical motor oscillation angle. (K. Dimitris et al., 2010) However, it should be kept in mind that increasing the oscillation angle to improve the performance will increase the saw blade excursion distance and thus the deviation potential.

K. Dimitris et al., as a result of their research, suggested the use of the narrowest blade possible, with which cutting can be made easily. With the blade width, length and oscillating angle data, the probable blade excursion distance can be calculated. However, during the operation, it would be wrong to create a simple formula for determining the size of the saw blade to be used due to factors such as surgical motor control by human hand and differences in bone hardnesses.

In conclusion, in knee arthroplasty, proper saw blade and surgical power tools selection helps to reduce the risk of medial collateral ligament injury.

Click here to find more articles about Medial Collateral Ligament Injury via PubMed Website.

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  • Kirk Dimitris, MD, Benjamin C. Taylor, MD, and Robert N. Steensen, MD. 2010. Excursion of Oscillating Saw Blades in Total Knee Arthroplasty. The Journal of Arthroplasty Vol. 25 No. 1, pp. 158-160. Department of Orthopaedic Surgery, Mount Carmel Medical Center, Columbus, Ohio.
  • Major Seth S. Leopold, Medical Corps, United States Army, Chris Mcstay, BS, Karen Klafeta, BS, Joshua J. Jacobs, MD, Richard A. Berger, MD, And Aaron G. Rosenberg, MD. 2001. Primary Repair of Intraoperative Disruption of the Medial Collateral Ligament During Total Knee Arthroplasty. The Journal Of Bone & Joınt Surgery Volume 83-A · Number 1, pp. 86-91. Rush-Presbyterian-St. Luke’s Medical Center, Chicago, Illinois.
  • Xiaomeng Wang, MD, Huixin Liu, MD, Pengkai Cao, MD, Chang Liu, MD, Zhenyue Dong, MD, Jianchao Qi, MD, Fei Wang, DD. 2017. Clinical outcomes of medial collateral ligament injury in total knee arthroplasty. Medicine: July 2017 – Volume 96 – Issue 30 – p e7617. The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.

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