Sportverletzung-Sportschaden

Savio L-Y Woo


Healing of the Medial Collateral Ligament- Clinical treatment of complete healing of the medial lateral ligament of the knee continues to be a subject of debate. In this paper, we present laboratory experiments over the last 15 years to gain better under study involving biomechanical, biochemical, and histological evaluation of the healing MCL. Particularly, the involvement of measurement of varus-valgus knee joints instability in five degrees of freedom (DOF) case was found to be 220% higher than those for the more constraint 3 DOF case. To study the contribution to the valgus knee rotation, this 3 DOF test (by restricting axial-tibial rotation and anterior-posterior translation of the knee) is recommended. The bone-ligament-bone complex is tensile tested as a functional composite, (femur-MCL-tibia complex, (FMTC)). Both the load-elongation curve representing the structural properties of FMTC and the stress strain curve representing the mechanical properties of the healing ligament can be obtained from this method. Using an interdisciplinary approach, the effects of maturation, aging, and gender, effects of immobilization, effects of remobilization, and in-situ ligament tension and exercise effects of the rabbit MCL are presented. In terms of healing of ligaments, we've found that in the case of an isolated MCL transection, repair plus immobilization has no advantage over no repair and no immobilization. The structural properties of the FMTC and varus-valgus knee instability regained to normal by 12 weeks in the latter case, while the mechanical properties of the healed MCL did not reach that of the normal at 48 weeks. In the case of ligament rupture that includes damage to both the MCL substance and the insertion sites, the heal in between them was found to be asynchronous. Repair in the MCL again showed no effect. The structural characteristics of the FMTC returned to 2/3 of that of the normal at 52 weeks. The mechanical properties of the healed MCL was 25-30% of normal. The cross sectional area of the healing site was significantly enlarged. In a study that included ACL injury in addition to the MCL injury we've found that the varus-valgus knee laxity remained elevated at 3.5 times greater than control at 12 weeks. The ultimate load of the FMTC reached that of 80% of the control while the tensile strength of the healed MCL reached only 14% of the control. When the injury included partial minesectimy, the results were even less satisfactory as the healed MCL had an extremely large mass to make up for the deficiencies of its quality. In summary, our data suggest that MCL can heal spontaneously without surgical intervention. Severity of ligament injury will play a role in the quality of the healed tissue. Therefore, mechanical and biochemical factors that could enhance its healing will need to be studied.