Blankenbaker Donna G, De Smet Arthur A, Fine Jason P
Division of Musculoskeletal Imaging, Department of Radiology, University of Wisconsin Medical School, Clinical Science Center-E3/311, 600 Highland Avenue, Madison, WI 53792-3252, USA.
Skeletal Radiol. 2005 Aug;34(8):462-7. doi: 10.1007/s00256-005-0931-x. Epub 2005 Jun 7.
Edema surrounding the medial collateral ligament (MCL) is seen on MR imaging in patients with MCL injuries and in patients with radiographic osteoarthritis in the non-traumatic knee. Because we noted MCL edema in patients without prior trauma or osteoarthritis, we studied the association between intra-articular pathology and MCL edema in patients without knee trauma.
We evaluated the MR examinations of 247 consecutive patients (121 male, 126 female with a mean age of 44 years) without recent trauma for the presence of edema surrounding the MCL, meniscal and ACL tears, medial meniscal extrusion, medial compartment chondromalacia, and osteoarthritis. The percentages of patients illustrating MCL edema with and without each type of pathology were compared using Fisher's exact test to determine if there was a statistically significant association.
We found MCL edema in 60% of 247 patients. MCL edema was present in 67% of patients with medial meniscal tears, 35% with lateral meniscal tears, 100% with meniscal extrusion of 3 mm or more, 78% with femoral chondromalacia, 82% with tibial chondromalacia, and 50% with osteoarthritis. The percentage of patients with edema increased with the severity of the chondromalacia. These associations were all statistically significant (p <0.02). The mean age of those with MCL edema was 49.7 years compared with 34.9 years without MCL edema ( p <0.001). Patient gender and ACL tear did not correlate with MCL edema. Nine (4%) of the 247 patients had MCL edema without intra-articular pathology. None of these 9 patients had MCL tenderness or joint laxity on physical examination.
We confirmed that MCL edema is associated with osteoarthritis, but is also associated with meniscal tears, meniscal extrusion, and chondromalacia. In addition, MCL edema can be seen in patients without intra-articular pathology, recent trauma or MCL abnormality on physical examination.
内侧副韧带（MCL）损伤患者以及非创伤性膝关节影像学骨关节炎患者的磁共振成像（MR）检查可见MCL周围水肿。由于我们注意到无既往创伤或骨关节炎患者存在MCL水肿，因此我们研究了无膝关节创伤患者关节内病变与MCL水肿之间的关联。
我们评估了247例近期无创伤患者（121例男性，126例女性，平均年龄44岁）的MR检查结果，以确定是否存在MCL周围水肿、半月板和前交叉韧带（ACL）撕裂、内侧半月板挤压、内侧间室软骨软化以及骨关节炎。使用Fisher精确检验比较出现和未出现每种病变类型的MCL水肿患者的百分比，以确定是否存在统计学上的显著关联。
我们在247例患者中的60%发现了MCL水肿。内侧半月板撕裂患者中67%存在MCL水肿，外侧半月板撕裂患者中35%存在，半月板挤压3毫米或以上患者中100%存在，股骨软骨软化患者中78%存在，胫骨软骨软化患者中82%存在，骨关节炎患者中50%存在。软骨软化严重程度越高，水肿患者的百分比越高。这些关联均具有统计学意义（p<0.02）。有MCL水肿患者的平均年龄为49.7岁，无MCL水肿患者为34.9岁（p<0.001）。患者性别和ACL撕裂与MCL水肿无关。247例患者中有9例（4%）无关节内病变却有MCL水肿。这9例患者在体格检查中均无MCL压痛或关节松弛。
我们证实MCL水肿与骨关节炎有关，但也与半月板撕裂、半月板挤压和软骨软化有关。此外，在无关节内病变、近期创伤或体格检查中无MCL异常的患者中也可见MCL水肿。
