Bollier Matthew, Smith Patrick A
Department of Orthopaedic Surgery, University of Iowa Sports Medicine, Iowa City, Iowa.
Columbia Orthopaedic Group, Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri.
J Knee Surg. 2014 Oct;27(5):359-68. doi: 10.1055/s-0034-1381961. Epub 2014 Jun 20.
The diagnosis and treatment of combined anterior cruciate ligament (ACL) and medial collateral ligament (MCL) injuries have evolved over the past 30 years. A detailed physical examination along with careful review of the magnetic resonance imaging and stress radiographs will guide decision making. Early ACL reconstruction and acute MCL repair are recommended when there is increased medial joint space opening with valgus stress in extension, a significant meniscotibial deep MCL injury (high-riding medial meniscus), or a displaced tibial-sided superficial MCL avulsion (stener lesion of the knee). Delayed ACL reconstruction to allow for MCL healing is advised when increased valgus laxity is present only at 30 degrees of flexion and not at 0 degree. However, at the time of ACL surgery, medial stability has to be re-assessed after the reconstruction is completed. In patients with neutral alignment in the chronic setting, graft reconstruction of both the ACL and MCL is recommended.
在过去30年里，前交叉韧带（ACL）和内侧副韧带（MCL）联合损伤的诊断和治疗方法不断演变。详细的体格检查以及对磁共振成像和应力X线片的仔细评估将指导决策制定。当伸直位外翻应力下内侧关节间隙增宽、存在明显的半月板胫骨深层MCL损伤（内侧半月板高位）或胫骨侧浅表MCL撕脱移位（膝关节斯滕纳病变）时，建议早期进行ACL重建和急性MCL修复。当仅在屈膝30度时存在外翻松弛增加而伸直位0度时不存在时，建议延迟ACL重建以促进MCL愈合。然而，在ACL手术时，重建完成后必须重新评估内侧稳定性。对于慢性状态下力线正常的患者，建议同时进行ACL和MCL的移植物重建。
