Department of Orthopaedic Surgery, University of Pennsylvania, 1 Cupp Pavilion, 39th and Market Streets, Philadelphia, PA 19104, USA.
Clin Orthop Relat Res. 2011 Jan;469(1):64-8. doi: 10.1007/s11999-010-1502-6.
Intraoperative injuries to the medial collateral ligament are often unrecognized and failure to appropriately manage ligament loss may result in knee instability and loosening.
QUESTIONS/PURPOSES: We compared the functional scores in patients with iatrogenic injury to the medial collateral ligament (MCL) treated with additional constraint to those without.
We retrospectively reviewed the records of all 1478 patients (1650 knees) who underwent primary TKA between 1998 and 2004. Thirty-seven patients (2.2%) had recognized intraoperative injury to the MCL; the remaining 1441 patients (1613 knees) served as controls. We attempted to repair the ligament in 14 patients; increased prosthetic constraint over that planned was used in 30 of the 37 patients. We determined Knee Society scores (KSS) in all patients. Three patients were lost to followup. The minimum followup was 36 months (average, 54 months; range, 36-120 months).
The mean KSS for all MCL injury knees for pain and function averaged 81 and 74 points, respectively, compared with 91 and 87 for the control group. However, in the 30 knees in which the MCL insufficiency was treated with increased constraint, the mean scores for pain and function increased to 88 and 83 points, respectively. Four of the seven patients treated without increased prosthetic constraint were revised for instability; no revisions for instability were performed in the 37 patients treated with additional constraint.
Recognition of MCL injury during TKA is crucial, since using nonstabilizing inserts was associated with residual instability requiring revision.
Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
术中内侧副韧带损伤经常未被识别，如果未能适当处理韧带损失，可能导致膝关节不稳定和松动。
问题/目的：我们比较了内侧副韧带（MCL）医源性损伤患者接受额外约束治疗与未接受约束治疗的功能评分。
我们回顾性分析了 1998 年至 2004 年间接受初次 TKA 的 1478 例患者（1650 膝）的记录。37 例（2.2%）患者术中发生明确的 MCL 损伤；其余 1441 例（1613 膝）患者作为对照。我们尝试修复 14 例患者的韧带；37 例患者中，30 例使用了比计划增加的假体约束。我们对所有患者进行了膝关节学会评分（KSS）评估。有 3 例患者失访。最低随访时间为 36 个月（平均 54 个月；范围 36-120 个月）。
所有 MCL 损伤膝关节的平均 KSS 疼痛和功能评分分别为 81 和 74 分，而对照组分别为 91 和 87 分。然而，在 MCL 不稳定性用增加的约束治疗的 30 个膝关节中，疼痛和功能评分分别增加到 88 和 83 分。7 例未增加假体约束治疗的患者中有 4 例因不稳定而进行了翻修；37 例接受额外约束治疗的患者中没有不稳定进行翻修。
在 TKA 中识别 MCL 损伤至关重要，因为使用非稳定插入物与需要翻修的残留不稳定有关。
IV 级，治疗研究。有关证据水平的完整描述，请参见作者指南。
