Biomechanical Analysis of Internal Bracing for Treatment of Medial Knee Injuries

Orthopedics. 2016 May 1;39(3):e532-7. doi: 10.3928/01477447-20160427-13. Epub 2016 May 2.


The internal brace technique uses a high-strength suture tie to augment injured tissues or a primary repair, allowing early rehabilitation. Anatomic repair with internal bracing is a novel and promising treatment for femoral-sided medial knee avulsion injuries of the medial collateral ligament and posterior oblique ligament. Unfortunately, biomechanical and clinical data are lacking. To evaluate this technique compared with other treatment options, 3 assays of 9 cadaveric matched pairs (54 knees) were tested to failure at 30° under valgus load in a biomechanical testing apparatus. The primary outcome measure was moment at failure (Nm), with secondary outcome measures of stiffness (Nm/°), valgus angulation at 10 Nm (°), and valgus angulation at failure (°). Repair with internal bracing was compared with the intact state, repair alone, and allograft reconstruction. The mean moment to failure (62.5±24.9 Nm) for internal bracing was significantly lower than that for intact specimens (107.2±39.7 Nm) (P=.009). Mean moment to failure and valgus angle at failure were significantly greater for internal bracing (95±31.9 Nm) than for repair (73.4±27.6 Nm) (P=.05). Internal bracing was similar to reconstruction for the primary outcome measure (53.5±26.3 Nm vs 66.9±28.8 Nm) (P=.227) and for all secondary outcome measures. These findings indicate that posteromedial knee repair with internal bracing for femoral-sided avulsions is superior to repair alone and is similar to allograft reconstruction for all parameters measured; however, this technique did not recreate biomechanical properties equivalent to the intact state. [Orthopedics. 2016; 39(3):e532-e537.].

Publication types

  • Comparative Study

MeSH terms

  • Analysis of Variance
  • Biomechanical Phenomena / physiology
  • Braces*
  • Cadaver
  • Femur / surgery
  • Humans
  • Knee Injuries / physiopathology
  • Knee Injuries / surgery*
  • Medial Collateral Ligament, Knee / injuries
  • Medial Collateral Ligament, Knee / surgery
  • Orthopedic Procedures / methods
  • Sutures
  • Transplantation, Homologous