Department of Orthopaedics, Third Hospital, Hebei Medical University, Shijiazhuang, China.
Arthroscopy. 2012 Oct;28(10):1445-53. doi: 10.1016/j.arthro.2012.03.024. Epub 2012 Jul 15.
The purpose of this study was to present a novel medial collateral ligament (MCL) reconstruction technique and investigate the clinical outcomes of this surgical procedure.
From July 2006 to June 2009, 56 patients with medial instability of the knee were treated with MCL reconstruction and followed up for 33 months on average. These patients were divided into 2 groups based on whether anterior cruciate ligament (ACL) injury was present: 27 patients had isolated MCL injury, whereas 29 patients had combined MCL-ACL injury. All patients underwent reconstruction of the MCL with triangular double-bundle allograft, and we evaluated International Knee Documentation Committee (IKDC) scores, anteromedial rotatory instability (AMRI), and excessive knee medial opening (EKMO) both preoperatively and at follow-up.
EKMO was significantly reduced to 2.9 mm at follow-up compared with 10.1 mm preoperatively. The incidence of AMRI was reduced to 9.4% (5 patients) compared with 67.9% (36 patients) preoperatively. Of the patients, 58.9% (33 patients) had a grade A IKDC subjective score and 35.7% (20 patients) had a grade B IKDC subjective score. Most patients had normal or nearly normal range of motion of the knee joint, whereas 4 patients (7.1%) lost more than 6° of range of motion in extension and 2 (3.6%) lost more than 25° in flexion. In 47 patients (83.9%) the symptoms were graded as normal or nearly normal according to IKDC symptom scores. No significant differences in IKDC subjective score, IKDC symptom score, flexion deficit score, AMRI, and EKMO were found between the isolated MCL injury group and the MCL-ACL injury group; however, a significant difference was found in knee extension deficit between groups.
We have presented a new technique for reconstruction of the MCL with a triangular shape. This technique improved both valgus and rotational stability at short-term outcome. The clinical outcomes using IKDC evaluation indicate that no major difference exists in isolated MCL injury and combined MCL-ACL injury treated with this new technique.
Level IV, therapeutic case series.
本研究旨在介绍一种新的内侧副韧带（MCL）重建技术，并探讨该手术的临床疗效。
自 2006 年 7 月至 2009 年 6 月，56 例膝关节内侧不稳定患者接受了 MCL 重建手术，平均随访 33 个月。根据是否合并前交叉韧带（ACL）损伤，将这些患者分为 2 组：27 例单纯 MCL 损伤，29 例 MCL-ACL 损伤。所有患者均采用三角双束同种异体移植物重建 MCL，我们分别在术前和随访时评估国际膝关节文献委员会（IKDC）评分、前内侧旋转不稳定（AMRI）和过度膝关节内侧张开（EKMO）。
与术前相比，EKMO 明显减少至 2.9mm。AMRI 的发生率从术前的 67.9%（36 例）降低至 9.4%（5 例）。其中，58.9%（33 例）患者的 IKDC 主观评分等级为 A，35.7%（20 例）为 B。大多数患者膝关节运动范围基本正常，4 例（7.1%）患者伸膝活动度丧失超过 6°，2 例（3.6%）患者屈膝活动度丧失超过 25°。根据 IKDC 症状评分，47 例（83.9%）患者症状评为正常或接近正常。在 IKDC 主观评分、IKDC 症状评分、屈曲缺损评分、AMRI 和 EKMO 方面，单纯 MCL 损伤组和 MCL-ACL 损伤组之间无显著差异；然而，两组间膝关节伸直缺损有显著差异。
我们提出了一种新的三角形状 MCL 重建技术。该技术在短期结果中改善了外翻和旋转稳定性。使用 IKDC 评估的临床结果表明，在采用该新技术治疗单纯 MCL 损伤和 MCL-ACL 损伤时，两者之间无明显差异。
IV 级，治疗性病例系列。
