Piątkowski Krzysztof, Płomiński Janusz, Sowiński Tomasz, Piekarczyk Piotr, Kwiatkowski Krzysztof, Gołos Justyna
Department of Orthopaedics, Military Institute of Medicine, Warsaw, Poland.
Department of Traumatology and Orthopaedics, Military Institute of Medicine, Warsaw, Poland.
Ortop Traumatol Rehabil. 2014 Jan-Feb;16(1):33-45. doi: 10.5604/15093492.1097487.
Proper treatment of massive knee injuries still constitutes a challenge for clinicians. Most often a torsion knee injury results in a rupture of the medial collateral ligament and anterior cruciate ligament. There is still no consensus on whether total rupture (Grade III) of the medial collateral ligament requires surgery, but it is well known that anterior cruciate ligament injury will require reconstructive surgery.
A total of 27 patients treated with two-staged surgery (primary MCL repair and delayed ACL reconstruction) were enrolled. Treatment outcomes were evaluated using the IKDC scale and Lysholm scale. The range of motion and knee stability was assessed during a clinical examination. Radiographs were used to evaluate the placement of suture anchors and development of osteoarthritic lesions. Static and dynamic ultrasound examinations were also performed to assess the post-operative morphology and performance of the medial collateral ligament.
The patients who had undergone surgery for combined anteromedial instability of the knee, achieved good or very good clinical outcome according to the IKDC scale (63%, 17 of 27) and the Lysholm scale (74%, 20 of 27). Unsatisfactory functional outcomes were more often seen in older patients. Some patients developed complications, which significantly worsened the outcome. Those mainly included a limited range of movement, arthrofibrosis and Pellegrini-Stieda lesions.
1.Two-stage operative treatment produces good or very good results in most patients. Nevertheless, there is a risk of complications in some cases, mostly in patients aged 40 years. Accordingly, two-stage treatment is currently recommended in younger individuals. 2. A complete MCL tear at the distal attachment should be given particular attention. Although such injury is rare, due to the anatomical determinants and the risk of Stener-like lesions, i.e. unhealed ML, surgery is recommended. Surgery produces good clinical and functional results.
对于严重膝关节损伤的恰当治疗仍是临床医生面临的一项挑战。多数情况下，膝关节扭转损伤会导致内侧副韧带和前交叉韧带断裂。对于内侧副韧带完全断裂（Ⅲ级）是否需要手术治疗，目前仍未达成共识，但众所周知，前交叉韧带损伤需要进行重建手术。
共纳入27例接受两阶段手术（一期内侧副韧带修复和二期前交叉韧带重建）治疗的患者。使用国际膝关节文献委员会（IKDC）评分量表和Lysholm评分量表评估治疗效果。在临床检查期间评估活动范围和膝关节稳定性。通过X线片评估缝线锚钉的位置及骨关节炎病变的发展情况。还进行了静态和动态超声检查，以评估术后内侧副韧带的形态和性能。
接受膝关节前内侧联合不稳定手术治疗的患者，根据IKDC评分量表（63%，27例中的17例）和Lysholm评分量表（74%，27例中的20例），取得了良好或非常好的临床效果。功能结局不满意在老年患者中更为常见。一些患者出现了并发症，这显著恶化了结局。主要包括活动范围受限、关节纤维化和佩莱格里尼 - 施蒂达（Pellegrini-Stieda）病变。
