Forkel P, Seppel G, Imhoff A, Petersen W
Abteilung für Sportorthopädie, Klinikum rechts der Isar, TU München, Ismaninger Str. 22, 81675, München, Deutschland,
Oper Orthop Traumatol. 2015 Apr;27(2):155-71. doi: 10.1007/s00064-015-0360-5. Epub 2015 Apr 10.
Restoration of the medial stability after acute lesion of the medial collateral ligament (MCL) and of the posteromedial complex in case of a high grade instability of the MCL. Stabilization against valgus stress and prevention of an increased posterior drawer in case of a lesion of the posterior oblique ligament (POL).
Acute high grade instability (grade 3) of the MCL. Rupture of the POL in combination with a rupture of the PCL and/or of the ACL. Multiligamentous injuries. Stener-like lesion of the tibial insertion of the MCL fibers with subluxation of the MCL superficial to the pes anserinus superficialis.
Local infection, poor soft tissue condition, severe soft tissue defects, intraligamentous injuries of the MCL (grade I-II instabilities).
The refixation of the MCL and the posteromedial complex has to respect anatomical situation. Femoral or tibial avulsions of the MCL can be reattached by the use of anchors at the anatomical insertion sites. Intraligamentous ruptures must be adapted. Additional framelike sutures may be used. The fixation and readaption of the MCL and the posteromedial complex can be combined with ACL and PCL procedures.
Use of a brace for 6 weeks to avoid valgus stress, partial weight bearing (10-20 kg). Weeks 1-3: ROM 0-20-60° extension/flexion; weeks 4-6: ROM 0-10-90° extension/flexion; after 7 weeks: free ROM. The postoperative protocol must be more restrictive in case of a combination of a MCL fixation and a PCL reconstruction (6 weeks immobilization in extension with posterior support, exercise only in prone position).
Between 2010 and 2013, 34 cases of acute medial instability were treated. According to the injury pattern, some procedures were isolated MCL refixations, while others were combined procedures. While 25 patients showed a concomitant ACL injury, 13 patients had combined PCL and ACL injury. Postoperatively all medial instabilities had improved. Revision surgery was performed in 3 cases due to postoperative arthrofibrosis.
在内侧副韧带（MCL）急性损伤后恢复内侧稳定性，以及在MCL高度不稳定时恢复后内侧复合体的稳定性。在斜后韧带（POL）损伤时抵抗外翻应力并防止后抽屉增加。
MCL急性高度不稳定（3级）。POL断裂合并后交叉韧带（PCL）和/或前交叉韧带（ACL）断裂。多韧带损伤。MCL纤维胫骨附着处类似斯滕纳（Stener）病变，MCL浅面在鹅足浅面半脱位。
局部感染、软组织条件差、严重软组织缺损、MCL韧带内损伤（I-II级不稳定）。
MCL和后内侧复合体的重新固定必须符合解剖情况。MCL的股骨或胫骨撕脱可通过在解剖附着部位使用锚钉重新附着。韧带内断裂必须进行调整。可使用额外的框架状缝线。MCL和后内侧复合体的固定和调整可与ACL和PCL手术相结合。
使用支具6周以避免外翻应力，部分负重（10-20千克）。第1-3周：活动度0-20-60°伸展/屈曲；第4-6周：活动度0-10-90°伸展/屈曲；7周后：活动度自由。如果MCL固定和PCL重建联合进行，术后方案必须更严格（伸直位并使用后支撑固定6周，仅在俯卧位进行锻炼）。
2010年至2013年期间，治疗了34例急性内侧不稳定病例。根据损伤类型，一些手术是单纯的MCL重新固定，而其他是联合手术。25例患者伴有ACL损伤，13例患者合并PCL和ACL损伤。术后所有内侧不稳定情况均有改善。3例因术后关节纤维性粘连进行了翻修手术。
