Chen Zhiwei, Sheng Zhen, Dai Zhu
Department of Orthopaedics, the First Affiliated Hospital of University of South China, Hengyang Hunan, 421001, PR China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2013 May;27(5):586-90.
To investigate the methods and effectiveness of surgical treatment for posteromedial corner (PMC) injury combined with anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) ruptures.
Between February 2009 and February 2012, 15 patients (15 knees) with PMC injury combined with ACL and PCL ruptures underwent PMC repair with suture anchor and ACL and PCL reconstruction. There were 7 males and 8 females with an average age of 39 years (range, 15-59 years). The causes of injury were traffic accident injury in 6 cases, sport injury in 7 cases, and sprain injury in 2 cases. The disease duration was 3-15 days with an average of 7 days. All patients presented positive results of anterior drawer test, posterior drawer test and valgus stress test, and dysfunction of knee joint. Of 15 cases, 3 had ACL and PCL ruptures, 5 had ACL rupture, 3 had ACL injury at the attachment point of the condyles crest, and 4 had PCL rupture; 9 had PMC tear at the femur insertion, 5 had PMC tear at the tibia insertion, and 1had PMC tear in the body area.
All incisions healed by first intention with no complication of infection or stiffness of knee. All cases were followed up 18.4 months on average (range, 10-36 months). At last follow-up, 14 cases had normal knee flexion and extension ranges, but 1 case had 10 degree limitation of the knee extension. Except 1 case which had weakly positive valgus stress test, the other patients showed negative results of anterior drawer test, posterior drawer test, and valgus stress test. Based on the improved Lysholm classification standard, the results were excellent in 8 cases, good in 5 cases, and fair in 2 cases; the excellent and good rate was 86.7%.
Early repair of the PMC and reasonable reconstruction of cruciate ligament can effectively restore the knee stability for patients with PMC injury combined with ACL and PCL ruptures.
探讨后内侧角（PMC）损伤合并前交叉韧带（ACL）及后交叉韧带（PCL）断裂的手术治疗方法及疗效。
2009年2月至2012年2月，15例（15膝）PMC损伤合并ACL及PCL断裂患者接受了缝线锚钉修复PMC及ACL、PCL重建术。其中男性7例，女性8例，平均年龄39岁（15 - 59岁）。受伤原因：交通事故伤6例，运动损伤7例，扭伤2例。病程3 - 15天，平均7天。所有患者前抽屉试验、后抽屉试验及外翻应力试验均为阳性，膝关节功能障碍。15例中，3例为ACL及PCL断裂，5例为ACL断裂，3例为髁嵴附着点处ACL损伤，4例为PCL断裂；9例为股骨止点处PMC撕裂，5例为胫骨止点处PMC撕裂，1例为体部PMC撕裂。
所有切口均一期愈合，无感染及膝关节僵硬并发症。所有病例平均随访18.4个月（10 - 36个月）。末次随访时，14例膝关节屈伸范围正常，但1例膝关节伸直受限10度。除1例外翻应力试验弱阳性外，其余患者前抽屉试验、后抽屉试验及外翻应力试验均为阴性。根据改良Lysholm评分标准，结果为优8例，良5例，可2例；优良率为86.7%。
早期修复PMC并合理重建交叉韧带可有效恢复PMC损伤合并ACL及PCL断裂患者的膝关节稳定性。
