Ateschrang A, Döbele S, Freude T, Stöckle U, Schröter S, Kraus T M
BG Trauma Center Tübingen, Eberhard Karls University, Schnarrenbergstr. 95, 72076, Tübingen, Germany.
Arch Orthop Trauma Surg. 2016 Sep;136(9):1265-1272. doi: 10.1007/s00402-016-2497-6. Epub 2016 Jul 19.
There is an on-going discussion whether to operatively treat combined grade II and III lesions of the medial collateral ligament (MCL) with anterior cruciate ligament (ACL) in the acute phase rather than conservative treatment of the MCL lesion with a delayed unitary ACL replacement. Another issue is the question how to technically address these MCL lesions. The aim of this study was, therefore, to analyze the results of simultaneous ACL replacement (hamstrings) in a single-bundle technique with a simultaneous MCL ligament bracing procedure.
In this prospective non-randomized trial,, 16 patients were included with grade II and III lesions of the MCL. Surgical treatment was performed within 14 days (mean 10.4 days, SD ±2.3 days) by one single expert orthopedic surgeon using the semitendinosus tendon and Rigidfix® system for femoral and tibial fixation and 3.5 mm screws with one 1.3 mm PDS Cord for minimal-invasive MCL ligament bracing with screw fixation. Knee stability was measured with the Rolimeter® and KT-1000®. MCL stability was assessed in clinically and radiographically with valgus stress projections.
The mean patient age was 36.4 with six female and ten male patients. There were no surgical complications such as infections or healing disturbances. Mean operation time was 64 ± 6 min. The arthrofibrosis rate was 0 %. Medial knee stability was normal in full extension for all cases with no intra-individual side-to-side difference. Radiological assessed MCL stability revealed Δ values with a mean of 1.1 ± 1.3 mm compared to the contra-lateral side. The Lachman Test revealed a side-to-side difference of 1.6 mm with the KT-1000® and 2.6 ± 0.9 mm when measured with the Rolimeter®. Subjective clinical assessment revealed good results with a mean Lysholm Score of 89.1 points.
Acute ACL replacement and MCL ligament bracing with this novel technique revealed in this study good clinical results and objective restored knee stability without cases of knee stiffness or arthrofibrosis. The remarkable shortcoming is the small cohort number making further studies necessary.
对于内侧副韧带（MCL）合并前交叉韧带（ACL）的II级和III级损伤，在急性期是进行手术治疗还是对MCL损伤采取保守治疗并延迟进行单一的ACL置换，目前仍在讨论中。另一个问题是如何从技术上处理这些MCL损伤。因此，本研究的目的是分析采用单束技术同时进行ACL置换（腘绳肌腱）并同时进行MCL韧带支撑手术的结果。
在这项前瞻性非随机试验中，纳入了16例MCL II级和III级损伤的患者。由一位骨科专家在14天内（平均10.4天，标准差±2.3天）进行手术治疗，使用半腱肌腱和Rigidfix®系统进行股骨和胫骨固定，并用3.5毫米螺钉和一根1.3毫米PDS线进行微创MCL韧带支撑并螺钉固定。使用Rolimeter®和KT-1000®测量膝关节稳定性。通过外翻应力投照从临床和影像学上评估MCL稳定性。
患者平均年龄为36.4岁，其中女性6例，男性10例。没有发生感染或愈合障碍等手术并发症。平均手术时间为64±6分钟。关节纤维化率为0%。所有病例在完全伸展时内侧膝关节稳定性正常，个体两侧无差异。影像学评估的MCL稳定性显示，与对侧相比，Δ值平均为1.1±1.3毫米。Lachman试验显示，使用KT-1000®测量时两侧差异为1.6毫米，使用Rolimeter®测量时为2.6±0.9毫米。主观临床评估显示结果良好，Lysholm评分平均为89.1分。
本研究中采用这种新技术进行急性ACL置换和MCL韧带支撑显示出良好的临床效果，膝关节稳定性客观恢复，无膝关节僵硬或关节纤维化病例。明显的缺点是样本量小，需要进一步研究。
