Steadman Philippon Research Institute, Vail, CO 81657, USA.
J Orthop Sports Phys Ther. 2012 Mar;42(3):221-33. doi: 10.2519/jospt.2012.3624. Epub 2012 Feb 29.
Injuries to the medial side of the knee are the most common knee ligament injuries. The majority of injuries occur in young athletes during sporting events, with the usual mechanism involving a valgus contact, tibial external rotation, or a combined valgus and external rotation force delivered to the knee. Although most complete grade III medial knee injuries heal, some do not, which can lead to continued instability. For these patients, a thorough understanding of the presenting history and a physical examination are important because these injuries can often be confused with posterolateral corner injuries. The main anatomic structures of the medial side of the knee are the superficial medial collateral ligament, deep medial collateral ligament, and posterior oblique ligament. In addition, accurately locating 3 bony prominences over the medial aspect of the knee-the adductor tubercle, gastrocnemius tubercle, and medial epicondyle-is important to conduct a proper physical examination and for surgical repairs and reconstructions. Clinical diagnosis of medial knee injuries is primarily performed via the application of a valgus stress in full extension and at 30° of knee flexion. In addition, an examination of the amount of anteromedial tibial rotation is performed at 90° of flexion, while the dial test, performed at 30° and 90° of flexion, is important because it evaluates for rotational abnormalities. Valgus stress radiographs are useful to objectively determine the amount of medial compartment gapping and to discern whether there is medial or lateral compartment gapping when a medial or posterolateral corner knee injury cannot be differentiated, especially with a chronic injury. The majority of acute grade III medial knee injuries will heal after a nonoperative rehabilitation program. In most instances when there is a knee dislocation or multiligament injury, a primary repair with sutures may be indicated. In severe midsubstance injuries or chronic medial knee injuries, an anatomic medial knee reconstruction with grafts may be indicated. Rehabilitation principles for acute medial knee injuries involve controlling edema, regaining range of motion, and avoiding any significant stress on the healing ligaments. A well-guided rehabilitation program can result in excellent functional outcomes in the majority of patients.
膝关节内侧损伤是最常见的膝关节韧带损伤。大多数损伤发生在运动过程中的年轻运动员中，常见的损伤机制包括外翻接触、胫骨外旋或外翻和外旋联合力作用于膝关节。虽然大多数完全 III 度内侧膝关节损伤可愈合，但有些不能愈合，这可能导致持续不稳定。对于这些患者，详细了解病史和体格检查非常重要，因为这些损伤常与后外侧角损伤相混淆。膝关节内侧的主要解剖结构包括浅层内侧副韧带、深层内侧副韧带和后斜韧带。此外，准确定位膝关节内侧的 3 个骨性突起——收肌结节、腓肠肌结节和内侧髁——对于进行适当的体格检查以及进行手术修复和重建非常重要。内侧膝关节损伤的临床诊断主要通过在完全伸展和 30°膝关节屈曲时施加外翻应力来进行。此外，还在膝关节屈曲 90°时检查前内侧胫骨旋转程度，而在膝关节屈曲 30°和 90°时进行的Dial 试验非常重要，因为它可以评估旋转异常。外翻应力位 X 线片有助于客观确定内侧间室间隙的量，并在无法区分内侧或后外侧角膝关节损伤时（尤其是慢性损伤时）辨别内侧或外侧间室间隙。大多数急性 III 度内侧膝关节损伤在非手术康复计划后可愈合。在大多数情况下，当膝关节脱位或多韧带损伤时，可能需要进行缝线的初次修复。在严重的中间体损伤或慢性内侧膝关节损伤中，可能需要进行解剖学内侧膝关节重建术。急性内侧膝关节损伤的康复原则包括控制肿胀、恢复活动范围以及避免对愈合韧带产生任何显著的压力。经过良好指导的康复计划可以使大多数患者获得良好的功能结果。
