Jones Luke, Bismil Quamar, Alyas Faisal, Connell David, Bell Jonathan
Oxford Deanery, 38 College Court, Queen Caroline Street, London, W6 9DZ, United Kingdom.
Knee. 2009 Jan;16(1):64-8. doi: 10.1016/j.knee.2008.09.002. Epub 2008 Oct 19.
Incomplete injuries (grade I or II) to the medial collateral ligament (MCL) of the knee are common and usually self limiting. Some patients complain of chronic medial knee pain following injury. We highlight the importance of anatomical investigation of these patients and evaluate a successful treatment technique. A consecutive case series of 34 patients with chronic pain following grade I/II MCL injury were reviewed. Injury prevented sporting activity, and examination revealed thickening and tenderness of the MCL. The knee was assessed by MRI. All patients had radiological evidence of injury to the superficial and deep MCL, with thickening, scarring and tearing. Patients were treated with ultrasound guided injection of local anaesthetic and steroid into the deep MCL and clinically reassessed. They were allowed to return to sport immediately. They were assessed for recurrence of symptoms with a postal questionnaire. Four were excluded from follow up. Four were lost. All patients reported an immediate and sustained resolution their medial knee pain. At mean follow up of 20.4 months (range 11-38 months) all were back to their pre-injury level of work. Twenty five (96%) had immediate and sustained return to sporting activity. Twenty one (81%) reported no change in level of sporting function. In patients with persistent medial joint pain following grade I/II MCL sprain, pain from the deep MCL must be considered. MRI will confirm the diagnosis, exclude coexistent pathology and localise the lesion within the deep MCL. A single corticosteroid injection provides an excellent clinical outcome 20 months post injection.
膝关节内侧副韧带（MCL）的不完全损伤（I级或II级）很常见，通常可自愈。一些患者在受伤后抱怨膝关节内侧慢性疼痛。我们强调对这些患者进行解剖学检查的重要性，并评估一种成功的治疗技术。回顾了一组连续的34例I/II级MCL损伤后慢性疼痛的患者病例系列。损伤导致无法进行体育活动，检查发现MCL增厚且有压痛。通过MRI对膝关节进行评估。所有患者均有浅、深MCL损伤的影像学证据，表现为增厚、瘢痕形成和撕裂。对患者进行超声引导下将局部麻醉剂和类固醇注射到深MCL内的治疗，并进行临床重新评估。允许他们立即恢复运动。通过邮寄问卷对他们进行症状复发评估。4例被排除在随访之外。4例失访。所有患者均报告膝关节内侧疼痛立即且持续缓解。平均随访20.4个月（范围11 - 38个月）时，所有患者均恢复到受伤前的工作水平。25例（96%）立即且持续恢复了体育活动。21例（81%）报告体育功能水平无变化。在I/II级MCL扭伤后持续存在膝关节内侧疼痛的患者中，必须考虑深MCL引起的疼痛。MRI将确诊、排除并存的病变并将病变定位在深MCL内。单次皮质类固醇注射在注射后20个月可提供出色的临床效果。
