Halinen Jyrki, Lindahl Jan, Hirvensalo Eero, Santavirta Seppo
Jorvi Hospital, Helsinki, Finland.
Am J Sports Med. 2006 Jul;34(7):1134-40. doi: 10.1177/0363546505284889. Epub 2006 Feb 1.
The apparent consensus is that solitary medial collateral ligament rupture can be treated nonoperatively, but treatment of severe combined ruptures of the medial collateral ligament and anterior cruciate ligament remains controversial.
Nonoperative and early operative treatments of grade III medial collateral ligament rupture lead to similar results when the anterior cruciate ligament is reconstructed in the early phase.
Randomized controlled clinical trial; Level of evidence, 1.
Forty-seven consecutive patients with combined anterior cruciate ligament and grade III medial collateral ligament injuries were randomized into 2 groups. The medial collateral ligament injury was treated operatively in group 1 (n = 23) and non-operatively in group 2 (n = 24). In both groups, the anterior cruciate ligament injury was treated with early reconstruction, using bone-patellar tendon-bone graft and interference screw. Two years postoperatively, knee stability was measured with a KT-1000 arthrometer and Telos valgus radiography and knee extension strength with a Biodex dynamometer and a 1-legged hop test. An International Knee Documentation Committee evaluation form and Lysholm score were completed.
All 47 patients were available for clinical evaluation for a mean of 27 months (range, 20-37 months) after surgery. There were no statistically significant differences between the 2 groups with respect to subjective function of the knee, postoperative stability, range of motion, muscle power, return to activities, Lysholm score, and overall International Knee Documentation Committee evaluation. The subjective outcome and Lysholm score were good and anteroposterior knee stability excellent in both groups.
Nonoperative and operative treatments of medial collateral ligament injuries lead to equally good results. Medial collateral ligament ruptures need not be treated operatively when the anterior cruciate ligament is reconstructed in the early phase.
目前普遍的共识是，孤立性内侧副韧带断裂可采用非手术治疗，但内侧副韧带与前交叉韧带严重联合断裂的治疗仍存在争议。
在前交叉韧带早期重建时，Ⅲ度内侧副韧带断裂的非手术治疗和早期手术治疗效果相似。
随机对照临床试验；证据等级，1级。
47例连续性前交叉韧带合并Ⅲ度内侧副韧带损伤患者被随机分为2组。第1组（n = 23）对内侧副韧带损伤行手术治疗，第2组（n = 24）行非手术治疗。两组均对前交叉韧带损伤行早期重建，采用骨-髌腱-骨移植物和挤压螺钉。术后2年，使用KT-1000关节测量仪和Telos外翻X线片测量膝关节稳定性，使用Biodex测力计和单腿跳测试评估膝关节伸展力量。完成国际膝关节文献委员会评估表和Lysholm评分。
47例患者术后平均27个月（范围20 - 37个月）均接受了临床评估。两组在膝关节主观功能、术后稳定性、活动范围、肌肉力量、恢复活动情况、Lysholm评分以及国际膝关节文献委员会总体评估方面均无统计学显著差异。两组的主观结果和Lysholm评分均良好，膝关节前后稳定性均优秀。
内侧副韧带损伤的非手术治疗和手术治疗效果同样良好。在前交叉韧带早期重建时，内侧副韧带断裂无需手术治疗。
