deMeireles Alirio J, El-Othmani Mouhanad M, Gardner Thomas R, Zhang Hui, Sarpong Nana O, Herndon Carl L, Shah Roshan P, Cooper H John, Geller Jeffrey A, Neuwirth Alexander L
Department of Orthopedic Surgery, Columbia University Irving Medical Center-New York Presbyterian Hospital, New York, NY.
Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island.
J Bone Joint Surg Am. 2025 May 23;107(13):1500-1505. doi: 10.2106/JBJS.24.01327.
An intraoperative midsubstance injury to the medial collateral ligament (MCL) is a devastating complication of total knee arthroplasty (TKA). No single treatment method has been shown to yield optimal stability. This cadaveric study compared primary MCL repair, increasing prosthetic constraint, and a combination of both techniques on tibiofemoral compartment gapping after an iatrogenic MCL injury.
We performed 16 cadaveric, robotic-assisted TKAs (CORI; Smith+Nephew) and recorded tibiofemoral gap measurements at 10°, 30°, 60°, and 90° of flexion with a posterior-stabilized (PS) prosthesis as the control group. The experimental groups had no MCL repair and a PS component, no MCL repair and a varus-valgus constrained (VVC) component, MCL repair with a PS component, and MCL repair with a VVC component. The MCL was repaired with 2 figure-8 nonabsorbable sutures. Gap measurements were manually tensioned by the same surgeon for all specimens. The mean medial tibiofemoral gap with the 3 different methods of interest (the no MCL repair with VVC component group, the MCL repair with PS component group, and the MCL repair with VVC component group) was compared with the control group for the rate of deficit (RD) and was compared with the no MCL repair and PS component group for the rate of improvement (RI). Simple statistics were used to calculate the mean medial balance for the groups, and analysis of variance (ANOVA) modeling was used to determine the mean changes in RD and RI, with significance set at p < 0.05.
The mean RD was highest for the no MCL repair with PS component group at 621.13%, demonstrating an approximately 6-fold increase in medial tibiofemoral gapping compared with the control group. This was followed by the no MCL repair with VVC component group at 93.02%, the MCL repair with PS component group at 65.66%, and the MCL repair with VVC component group at 20.01% (p < 0.001). The mean RI for the MCL repair with VVC component group was highest at 83.08%, meaning that the combination of VVC component and MCL repair resulted in an 83% improvement in medial tibiofemoral gapping from no MCL repair with PS component. This was followed by the MCL repair with PS component group at 76.62% and the no MCL repair with VVC component group at 72.95% (p < 0.001).
This cadaveric study demonstrates that primary MCL repair with VVC component was the best for minimizing the deficit after an MCL injury and provided the highest RI. MCL repair with PS component and no MCL repair with VVC component were less effective reconstructive choices. This study supports the combination of a simple MCL repair with VVC component as the most stable reconstructive option following an intraoperative MCL injury.
内侧副韧带（MCL）术中实质部损伤是全膝关节置换术（TKA）的一种灾难性并发症。尚无单一治疗方法能产生最佳稳定性。本尸体研究比较了初次MCL修复、增加假体约束以及这两种技术联合应用对医源性MCL损伤后胫股关节间隙的影响。
我们进行了16例尸体机器人辅助TKA（CORI；史赛克公司），并使用后稳定型（PS）假体记录屈膝10°、30°、60°和90°时的胫股关节间隙测量值作为对照组。实验组分别为不进行MCL修复并使用PS假体、不进行MCL修复并使用内翻-外翻约束（VVC）假体、进行MCL修复并使用PS假体以及进行MCL修复并使用VVC假体。MCL用2根8字不可吸收缝线修复。所有标本的间隙测量值均由同一位外科医生手动施加张力。将感兴趣的3种不同方法（不进行MCL修复并使用VVC假体组、进行MCL修复并使用PS假体组以及进行MCL修复并使用VVC假体组）的平均内侧胫股关节间隙与对照组比较缺损率（RD），并与不进行MCL修复并使用PS假体组比较改善率（RI）。使用简单统计方法计算各组的平均内侧平衡，并使用方差分析（ANOVA）模型确定RD和RI的平均变化，显著性设定为p < 0.05。
不进行MCL修复并使用PS假体组的平均RD最高，为621.13%，表明内侧胫股关节间隙比对照组增加了约6倍。其次是不进行MCL修复并使用VVC假体组，为93.02%，进行MCL修复并使用PS假体组为65.66%，进行MCL修复并使用VVC假体组为20.01%（p < 0.001）。进行MCL修复并使用VVC假体组的平均RI最高，为83.08%，这意味着VVC假体与MCL修复相结合使内侧胫股关节间隙从不进行MCL修复并使用PS假体时改善了83%。其次是进行MCL修复并使用PS假体组，为76.62%，不进行MCL修复并使用VVC假体组为72.95%（p < 0.001）。
本尸体研究表明，使用VVC假体进行初次MCL修复最有利于减少MCL损伤后的缺损，并提供最高的RI。进行MCL修复并使用PS假体以及不进行MCL修复并使用VVC假体是效果较差的重建选择。本研究支持在术中MCL损伤后，将简单的MCL修复与VVC假体相结合作为最稳定的重建选择。
