Clinical and Cadaveric Evidence for Inlay Technique Fixation in Ruptured MCL Inferior Attachment Treatment Running title: Inlay Technique Fixation for MCL Inferior Attachment Ruptures

Clinical and Cadaveric Evidence for Inlay Technique Fixation in Ruptured MCL Inferior Attachment Treatment Running title: Inlay Technique Fixation for MCL Inferior Attachment Ruptures | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Clinical and Cadaveric Evidence for Inlay Technique Fixation in Ruptured MCL Inferior Attachment Treatment Running title: Inlay Technique Fixation for MCL Inferior Attachment Ruptures Yu Zhang, Wentian Gao, Qiangqiang Li, Aikeremu Aierken, Ping Dong, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7828487/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 15 Jan, 2026 Read the published version in BMC Musculoskeletal Disorders → Version 1 posted 12 You are reading this latest preprint version Abstract Background Although well-documented for ligament graft fixation, the inlay technique remains largely unexplored for distal MCL avulsions, presenting a significant opportunity. A comprehensive evaluation of this approach utilizing an interference screw is now demanded, focusing on its biomechanical properties, kinematic influence, and ultimate clinical efficacy. Methods The MCL dynamic trajectories were recorded during full range of motion in three cadaveric specimens, and the mechanical strength were compared between inlay and onlay techniques using isokinetic tensile tests. Twenty-six patients with ruptured MCL inferior attachments underwent inlay technique fixation surgery 2 cm proximal to the distal insertion. Lateral stress tests, knee joint Lysholm scores, and MRIs used to evaluate knee stability and function. Results MCL dynamic trajectories showed no displacement within 3 cm of the ligament's distal end during full range of motion. Inlay technique exhibited significantly higher mechanical strength and shorter displacement compared to onlay technique. Twenty-six patients underwent this surgical technique, with negative lateral stress and drawer tests post-operation. Knee joint Lysholm scores significantly increased from 30 (17,48) pre-operation to 65 (30,90) at 3 months, 81 (60,95) at 6 months, and 90 (83,95) at 12 months post-operation (P < 0.05). MRI results showed satisfactory tendon-bone healing and ligament tension. Conclusions Inlay technique offers superior mechanical strength, earlier stability and tendon-bone healing for treating the inferior attachment of the MCL. An upward shift of the MCL insertion point within 3 cm does not impair knee joint motion trajectory. Level of evidence Level Ⅳ. Medial Collateral Ligament Inlay technique Bone Tunnel Fixation Biomechanics Motion trajectory Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 15 Jan, 2026 Read the published version in BMC Musculoskeletal Disorders → Version 1 posted Editorial decision: Revision requested 11 Dec, 2025 Reviews received at journal 10 Dec, 2025 Reviews received at journal 02 Dec, 2025 Reviewers agreed at journal 30 Nov, 2025 Reviews received at journal 29 Nov, 2025 Reviewers agreed at journal 25 Nov, 2025 Reviewers agreed at journal 05 Nov, 2025 Reviewers invited by journal 02 Nov, 2025 Editor assigned by journal 28 Oct, 2025 Editor invited by journal 27 Oct, 2025 Submission checks completed at journal 20 Oct, 2025 First submitted to journal 20 Oct, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7828487","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":543574073,"identity":"8b3b5b37-73c9-47e8-8f7f-8fe362791561","order_by":0,"name":"Yu Zhang","email":"","orcid":"","institution":"Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University","correspondingAuthor":false,"prefix":"","firstName":"Yu","middleName":"","lastName":"Zhang","suffix":""},{"id":543574074,"identity":"a45f19d2-2bf2-4072-98cb-d42a3fd14a48","order_by":1,"name":"Wentian Gao","email":"","orcid":"","institution":"Drum Tower Hospital 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Ruptures","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-musculoskeletal-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmsd","sideBox":"Learn more about [BMC Musculoskeletal Disorders](http://bmcmusculoskeletdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12891","title":"BMC Musculoskeletal Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Medial Collateral Ligament, Inlay technique, Bone Tunnel Fixation, Biomechanics, Motion trajectory","lastPublishedDoi":"10.21203/rs.3.rs-7828487/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7828487/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eAlthough well-documented for ligament graft fixation, the inlay technique remains largely unexplored for distal MCL avulsions, presenting a significant opportunity. A comprehensive evaluation of this approach utilizing an interference screw is now demanded, focusing on its biomechanical properties, kinematic influence, and ultimate clinical efficacy.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThe MCL dynamic trajectories were recorded during full range of motion in three cadaveric specimens, and the mechanical strength were compared between inlay and onlay techniques using isokinetic tensile tests. Twenty-six patients with ruptured MCL inferior attachments underwent inlay technique fixation surgery 2 cm proximal to the distal insertion. Lateral stress tests, knee joint Lysholm scores, and MRIs used to evaluate knee stability and function.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eMCL dynamic trajectories showed no displacement within 3 cm of the ligament's distal end during full range of motion. Inlay technique exhibited significantly higher mechanical strength and shorter displacement compared to onlay technique. Twenty-six patients underwent this surgical technique, with negative lateral stress and drawer tests post-operation. Knee joint Lysholm scores significantly increased from 30 (17,48) pre-operation to 65 (30,90) at 3 months, 81 (60,95) at 6 months, and 90 (83,95) at 12 months post-operation (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). MRI results showed satisfactory tendon-bone healing and ligament tension.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eInlay technique offers superior mechanical strength, earlier stability and tendon-bone healing for treating the inferior attachment of the MCL. An upward shift of the MCL insertion point within 3 cm does not impair knee joint motion trajectory.\u003c/p\u003e\u003ch2\u003eLevel of evidence\u003c/h2\u003e\u003cp\u003eLevel Ⅳ.\u003c/p\u003e","manuscriptTitle":"Clinical and Cadaveric Evidence for Inlay Technique Fixation in Ruptured MCL Inferior Attachment Treatment Running title: Inlay Technique Fixation for MCL Inferior Attachment Ruptures","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-12 19:11:22","doi":"10.21203/rs.3.rs-7828487/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-12-11T13:27:43+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-10T20:09:03+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-02T11:48:18+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"270049497798184760968267822997869661970","date":"2025-11-30T07:46:17+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-29T16:03:05+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"113413519927357133255612349531709048627","date":"2025-11-25T13:30:46+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"266948029292429803971202321752672135773","date":"2025-11-05T05:22:59+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-11-03T01:57:19+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-29T01:32:45+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-10-27T18:08:28+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-10-20T04:43:55+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Musculoskeletal Disorders","date":"2025-10-20T04:26:40+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-musculoskeletal-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmsd","sideBox":"Learn more about [BMC Musculoskeletal Disorders](http://bmcmusculoskeletdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12891","title":"BMC Musculoskeletal Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b9fa32d2-c882-4bec-bf78-81ab88643f03","owner":[],"postedDate":"November 12th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-01-19T17:22:12+00:00","versionOfRecord":{"articleIdentity":"rs-7828487","link":"https://doi.org/10.1186/s12891-025-09467-1","journal":{"identity":"bmc-musculoskeletal-disorders","isVorOnly":false,"title":"BMC Musculoskeletal Disorders"},"publishedOn":"2026-01-15 16:29:08","publishedOnDateReadable":"January 15th, 2026"},"versionCreatedAt":"2025-11-12 19:11:22","video":"","vorDoi":"10.1186/s12891-025-09467-1","vorDoiUrl":"https://doi.org/10.1186/s12891-025-09467-1","workflowStages":[]},"version":"v1","identity":"rs-7828487","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7828487","identity":"rs-7828487","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}