Dong Jiangtao, Wang Xiao Feng, Men Xiaoqian, Zhu Junjun, Walker Garth N, Zheng Xiao Zuo, Gao Jin Bao, Chen Baicheng, Wang Fei, Zhang Yingze, Gao Shi Jun
Department of Orthopaedic Center, Third Hospital, Hebei Medical University, Shijiazhuang, China.
Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A.
Arthroscopy. 2015 Jun;31(6):1108-16. doi: 10.1016/j.arthro.2014.12.010. Epub 2015 Mar 6.
The purpose of this study was to evaluate the clinical results of medial collateral ligament (MCL) anatomic ligament repair (ALR) and triangular ligament reconstruction (TLR) in treating acute grade III MCL injury with respect to imaging and functional results.
Between January 2009 and October 2011, a total of 69 patients with an acute grade III MCL tear combined with an anterior cruciate ligament tear were divided into 2 groups: those who underwent ALR and those who underwent TLR. Single-bundle anterior cruciate ligament reconstruction was also performed in all patients. A radiographic stress-position imaging test was performed to evaluate excessive medial opening of the knee. In addition, the Slocum test was carried out to assess anteromedial rotatory instability before surgery and at follow-up. The subjective symptoms and functional outcomes were evaluated preoperatively and postoperatively with International Knee Documentation Committee (IKDC) assessment.
Sixty-four patients with a mean follow-up period of 34 months were included in the final analysis. The measurement results for medial opening at the last follow-up appointment decreased significantly from the pretreatment measurements and fell within the normal range, without a statistically significant difference between the 2 groups (P > .05). The overall incidence of anteromedial rotatory instability was reduced to 21.9% compared with 62.5% preoperatively. However, the incidence of anteromedial rotatory instability in the TLR group (9.4%) decreased significantly compared with that in the ALR group (34.4%) (P < .05). All patients' IKDC subjective scores significantly improved after surgery. No statistically significant difference was found between the 2 groups at the last follow-up (P > .05). The comparison of IKDC extension and flexion deficit scores between the 2 groups showed no significant differences. Eleven patients in the ALR group and 4 in the TLR group complained of medial knee pain. The comparison between the 2 groups showed no significant difference (P > .05).
The clinical outcomes of this study showed that no major difference existed in the ALR and TLR groups based on IKDC scores and medial opening evaluations in the short-term. However, TLR offered better rotatory stability than ALR at final follow-up.
Level II, lesser-quality randomized controlled trial.
本研究旨在评估内侧副韧带（MCL）解剖韧带修复（ALR）和三角韧带重建（TLR）治疗急性III度MCL损伤在影像学和功能结果方面的临床疗效。
2009年1月至2011年10月期间，共有69例急性III度MCL撕裂合并前交叉韧带撕裂的患者被分为2组：接受ALR的患者和接受TLR的患者。所有患者均进行了单束前交叉韧带重建。进行X线应力位成像检查以评估膝关节内侧过度张开情况。此外，在手术前和随访时进行Slocum试验以评估前内侧旋转不稳定情况。术前和术后采用国际膝关节文献委员会（IKDC）评估对主观症状和功能结果进行评价。
最终分析纳入了64例平均随访期为34个月的患者。末次随访时内侧张开的测量结果与治疗前测量结果相比显著降低，且落在正常范围内，两组之间无统计学显著差异（P>.05）。前内侧旋转不稳定的总体发生率从术前的62.5%降至21.9%。然而，TLR组（9.4%）的前内侧旋转不稳定发生率与ALR组（34.4%）相比显著降低（P<.05）。所有患者术后IKDC主观评分均显著改善。末次随访时两组之间未发现统计学显著差异（P>.05）。两组之间IKDC伸展和屈曲缺陷评分的比较未显示出显著差异。ALR组有11例患者和TLR组有4例患者抱怨膝关节内侧疼痛。两组之间的比较未显示出显著差异（P>.05）。
本研究的临床结果表明，基于IKDC评分和短期内侧张开评估，ALR组和TLR组之间不存在重大差异。然而，在末次随访时，TLR比ALR提供了更好的旋转稳定性。
II级，质量较低的随机对照试验。
