POSTER ABSTRACTS - ISAKOS

medial collateral ligament (MCL) injury, is
inadequate for qualitative evaluation of the
severity and site of the MCL injury. Among the
various reported MRI classifications of MCL injury,
the most frequently used methods include the
Mink and Deutsch(M&D) classification, which
evaluates the superficial layer of the MCL, and the
Petermann classification, which evaluates both
the superficial and deep layers of the MCL. How
these systems relate to clinical instability, which
informs surgical indication, remains obscure.
Purpose: The purpose of this study was to
examine the usefulness and limitations of the
M&D and Petermann classifications of MCL
injuries that have been commonly employed in
recent years.
Methods: 24 patients with MCL injury underwent
MRI and treated surgically within one week of
injury. The patients were divided into two groups:
12 had isolated injuries, and 12 had multiple
ligament injuries. The MCL injuries in both two
groups were classified with M&D and Petermann
systems. The evaluation of each system were
compared with the AMA classification, and then
with the surgical findings to assess the correlation
between each of the classification systems and
knee instability. We also compared the accuracy of
prediction of the location of injury with the
surgical findings to assess the accuracy of MRI
detection of the injuries.
Results: Neither MRI classification system
correlated with AMA classification in either
patient group. Only the Petermann classification
correlated significantly with surgical findings, and
only in the multiple injury group. Both
classification systems were accurate for
assessment of disruption of the femoral insertion
in the isolated injury group, (sensitivity85.2%
specificity 89.0%). Both classification systems
were accurate for disruption of mid-substance in
the multiple injury group, (sensitivity72.2%
specificity83.3%).
Conclusions: Our study showed that instability of
the knee and the severity of MCL injury cannot be
thoroughly assessed by the M&D or Petermann
classification systems?but the predicted location
of MCL injury corresponded with surgical findings.
Both of the systems focus on partial or complete
tears of the MCL irrespective of the site of injury.
A future classification system that accurately
predicts the location and the severity of MCL
injury needs to be developed.
E-poster w/ Standard #642
Novel Technique for Ligament Fixation Using
Bone Graft
Tomonori Nagamine, Hiroshima, JAPAN,
Presenter
Mitsuo Ochi, Hiroshima, Hiroshima, JAPAN
Nobuo Adachi, Hiroshima, Hiroshima, JAPAN
Masataka Deie, Hiroshima, Hiroshima, JAPAN
Yoshimasa Ishii, Hiroshima, Hiroshima, JAPAN
Hiromi Kazusa, Hiroshima, Hiroshima, JAPAN
Hiroshima University, Hiroshima, JAPAN
(Purpose) The purposes of this study are to
introduce our novel technique for ligament
fixation using bone graft for the reconstruction of
medial collateral ligament (MCL) or posterolateral
structures (PLS) in the combined ligamentous
injuries, and to evaluate the efficacy of this
technique.
(Materials and Methods) In this technique, a
cylindrical bone plug (6.5mm in diameter, 15mm
in length) is harvested at the anatomical femoral
attachment of MCL or popliteal tendon using
Mosaicplasty system. After placing the graft in the
created bone socket, the bone plug is replaced
over the graft. The graft is secured with a spike
staple, after appropriate tension is applied to the
graft. Six patients with the combined ligamentous
injury underwent the MCL or PLS reconstruction
using this technique. They were 4 males and 2
females with the average age of 36.3 years (18 -
60). We performed the MCL reconstruction in 3
cases and the PLS reconstruction in 3 cases.
Autologous gracilis tendons were used in 5 cases
as a graft and allogeneic fascia lata in 1 case.
(Results) We chronologically evaluated the
functions of reconstructed ligament with MRI and
stress radiography. Postoperatively, joint stability
was excellent in all cases and the reconstructed
ligaments were well demonstrated by MRI. There
were no major complications during the operation
and postoperatively.
(Conclusion) This study clearly demonstrated the
efficacy of our novel technique to fix the graft with
bone block and staple in the reconstruction of
MCL or PLS. This ligament fixation technique can
provide rigid and less invasive fixation, because
distance between the fixation sites can be shorter
than that in the Endobutton technique.
Comparing to the fixation with only staple without
bone graft, bone graft may enhance the healing
process of tendon to bone fixation.