Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
Knee Surg Sports Traumatol Arthrosc. 2012 Jan;20(1):88-94. doi: 10.1007/s00167-011-1541-x. Epub 2011 May 10.
Although various surgical procedures have attempted to restore valgus stability in medial knee injuries, so far none has achieved satisfactory results. The purpose of this study was to assess clinical outcome for patients with grade 3 valgus instability who were treated according to our surgical management strategy.
Eighteen patients with both acute and chronic grade 3 medial knee injuries, all of which had combined cruciate ligament injuries, were treated with a proximal advancement of both the superficial medial collateral ligament (MCL) and posterior oblique ligament together with underlying deep MCL and joint capsule, in conjunction with cruciate ligament reconstructions in chronic phase. Augmentation with doubled semitendinosus tendon was added in 7 patients whose medial knee stability had been considered to be insufficient with only the proximal advancement procedure. They were evaluated preoperatively and at final follow-up.
Manual valgus laxities at 0° and 30°, as well as side-to-side difference in medial joint opening in stress radiograph, were significantly improved at final follow-up. The Lysholm knee scale was also significantly improved. Median values of the subjective evaluations of the patients' satisfaction, stability and sports performance level measured with visual analogue scale at final follow-up were 82 (60-100), 94 (71-100) and 88 (60-100), respectively.
Clinical outcomes of our surgical management strategy were reasonable in terms of restoring medial knee stability. This treatment protocol can help determine the surgical management of grade 3 medial knee injuries combined with cruciate ligament injuries.
Retrospective case series, Level IV.
尽管各种手术方法都试图恢复内侧膝关节损伤的外翻稳定性，但迄今为止，没有一种方法能取得满意的效果。本研究旨在评估根据我们的手术治疗策略治疗的 3 级外翻不稳定患者的临床结果。
18 例急性和慢性 3 级内侧膝关节损伤患者，均伴有交叉韧带损伤，采用浅层内侧副韧带（MCL）和后斜韧带的近端前向移位，结合深层 MCL 和关节囊，在慢性阶段进行交叉韧带重建。在 7 例仅行近端前向移位术时认为内侧膝关节稳定性不足的患者中，增加了双半腱肌腱增强。对所有患者进行术前和末次随访评估。
末次随访时，0°和 30°的手动外翻松弛度以及应力位片上内侧关节间隙的侧方差异均显著改善。Lysholm 膝关节评分也显著提高。末次随访时，患者满意度、稳定性和运动表现水平的主观评估的中位数值分别为 82（60-100）、94（71-100）和 88（60-100）。
就恢复内侧膝关节稳定性而言，我们的手术治疗策略的临床结果是合理的。该治疗方案有助于确定合并交叉韧带损伤的 3 级内侧膝关节损伤的手术治疗。
回顾性病例系列，IV 级。
