Is the Lind or LaPrade Technique Able to Control Anterior and Rotational Laxity in Medial-Side Knee Injuries? A...

Reconstruction of the medial collateral ligament (MCL) and posterior oblique ligament (POL) is necessary to restore stability in chronic lesions on the medial side of the knee. The Lind technique uses a single-strand, pedicled semitendinosus tendon autograft to perform continuous reconstruction of the MCL and POL. The LaPrade technique uses 2 free grafts: 1 graft for the MCL (double-strand semitendinosus tendon graft) and 1 graft for the POL (double-strand gracilis tendon graft).

To investigate the LaPrade and Lind techniques in restraining tibial translation and rotation induced by MCL + POL transection, simulating a grade 3 medial-side injury.

Controlled laboratory study.

A total of 18 fresh-frozen cadaveric lower limbs (mean age, 75 years [range, 62-94 years]; 14 men and 4 women), disarticulated at the hip, were examined. The MCL and POL of each knee were isolated. Each knee was subjected, at 30° of flexion, to anterior force up to 200 N and torque (internal and external tibial rotation) up to 5 N·m and measured with a laximeter (repeatability of motion within ±0.1 mm and ±0.1°) in the following states: intact knee, MCL Transection, MCL + POL transection, and finally MCL + POL reconstruction with either the Lind (9 knees) or LaPrade (9 knees) technique. The results were registered as laxity curves (in millimeters and degrees) after each state and then calculated as laxity increases (in millimeters and degrees) from the intact state. Residual laxity after reconstruction was presented as absolute values (Laxity Reconstructed - Laxity Intact [in millimeters or degrees]) and as relative values (Laxity Reconstructed - Laxity Intact / Laxity Transected - Laxity Intact × 100 [in percentages]). The Shapiro-Wilk test of normality, analysis of variance with the post hoc Bonferroni correction for multiple comparisons, and the Student t test were used.

In anterior tibial translation (ATT), the knees reconstructed with the Lind technique had a residual laxity of 0.70 ± 0.82 mm (66.7% ± 36.8%) compared with 1.21 ± 1.12 mm (78.1% ± 33.8%) using the LaPrade technique (P < .05). In internal rotation, the knees reconstructed with the Lind technique had a residual laxity of 0.92°± 0.79° (32.5% ± 34.7%) compared with 0.98°± 0.60° (35.9% ± 27.4%) using the LaPrade technique. In external rotation, the knees reconstructed with the Lind technique had a residual laxity of 0.48°± 0.60° (17.8% ± 20.5%) compared with 1.21°± 1.41° (30.3% ± 29.9%) using the LaPrade technique (P < .05).

MCL and POL reconstruction with either the Lind or LaPrade technique improved sagittal and rotatory stability compared with injured knees. The Lind technique had significantly less laxity in external rotation (P < .001) and ATT (P = .012) than the LaPrade technique. However, residual laxity in ATT and external rotation was low and may not be clinically significant. There was no significant difference in internal rotation (P = > .05). This is the first biomechanical study, to our knowledge, comparing these 2 "classic" techniques.

The Lind and LaPrade techniques did not restore native stability in translation and rotation. We believe that technical improvements or new techniques are essential for better knee control.