Varelas Antonios N, Erickson Brandon J, Cvetanovich Gregory L, Bach Bernard R
Rush University Medical Center, Chicago, Illinois, USA.
Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA.
Orthop J Sports Med. 2017 May 18;5(5):2325967117703920. doi: 10.1177/2325967117703920. eCollection 2017 May.
The medial collateral ligament (MCL) is the most frequently injured ligament of the knee, but it infrequently requires surgical treatment. Current literature on MCL reconstructions is sparse and offers mixed outcome measures.
PURPOSE/HYPOTHESIS: The purpose of this study was to compare the outcomes of isolated MCL reconstruction and multiligamentous MCL reconstruction. Our hypothesis was that in selective patients, MCL reconstruction would significantly improve objective and subjective patient knee performance measures, those being baseline valgus laxity, range of motion, objective and subjective International Knee Documentation Committee (IKDC) scores, Tegner score, and Lysholm knee activity scores.
Systematic review; Level of evidence, 4.
A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines and utilizing 3 computer-based databases. Studies reporting clinical outcomes of patients undergoing MCL reconstruction due to chronic instability or injury with mean follow-up of at least 2 years and levels of evidence 1 to 4 were eligible for inclusion. All relevant subject demographics and study data were statistically analyzed using 2-sample and 2-proportion tests.
Ten studies involving 275 patients met our inclusion criteria. Of these patients, 46 underwent isolated MCL reconstruction while another 229 underwent reconstruction of the MCL in addition to a variety of concomitant reconstructions. Overall outcomes for all patients were significant for (1) reducing the medial opening of the knee (8.1 ± 1.3 vs 1.4 ± 1.0 mm; < .001), (2) improving the patient's objective IKDC score (1.2% vs 88.4%; < .001), (3) improving the patient's subjective IKDC score (49.8 ± 6.9 vs 82.4 ± 9.6; < .001), and (4) improving the Lysholm knee activity score (69.3 ± 5.9 vs 90.5 ± 6.6; < .001). No differences existed between concomitant reconstruction groupings except that postoperative Lysholm scores were better for MCL/anterior cruciate ligament reconstruction than MCL/posterior cruciate ligament reconstruction (94.3 ± 4.5 vs 84.0 ± 11.7; < .001). Normal or nearly normal range of motion was obtained by 88% of all patients.
The systematic review of 10 studies and 275 knees found that the reported patient outcomes after MCL reconstruction were significantly improved across all measures studied, with no significant difference in outcomes between concomitant reconstructions.
内侧副韧带（MCL）是膝关节最常受伤的韧带，但很少需要手术治疗。目前关于MCL重建的文献稀少，且结果指标不一。
目的/假设：本研究的目的是比较单纯MCL重建和多韧带MCL重建的结果。我们的假设是，在选择性患者中，MCL重建将显著改善患者膝关节的客观和主观性能指标，即基线外翻松弛度、活动范围、客观和主观国际膝关节文献委员会（IKDC）评分、Tegner评分以及Lysholm膝关节活动评分。
系统评价；证据级别，4级。
按照系统评价和Meta分析的首选报告项目（PRISMA）指南进行系统评价，并利用3个基于计算机的数据库。报告因慢性不稳定或损伤接受MCL重建且平均随访至少2年、证据级别为1至4级的患者临床结果的研究符合纳入标准。所有相关受试者人口统计学和研究数据均使用双样本和双比例检验进行统计分析。
10项涉及275例患者的研究符合我们的纳入标准。在这些患者中，46例接受了单纯MCL重建，另外229例除了进行各种伴随重建外还进行了MCL重建。所有患者的总体结果在以下方面有显著改善：（1）减少膝关节内侧开口（8.1±1.3 vs 1.4±1.0 mm；P<.001），（2）改善患者的客观IKDC评分（1.2% vs 88.4%；P<.001），（3）改善患者的主观IKDC评分（49.8±6.9 vs 82.4±9.6；P<.001），（4）改善Lysholm膝关节活动评分（69.3±5.9 vs 90.5±6.6；P<.001）。伴随重建分组之间没有差异，只是MCL/前交叉韧带重建术后的Lysholm评分优于MCL/后交叉韧带重建（94.3±4.5 vs 84.0±11.7；P<.001）。所有患者中有88%获得了正常或接近正常的活动范围。
对10项研究和275个膝关节的系统评价发现，MCL重建后报告的患者结果在所有研究指标上均有显著改善，伴随重建之间的结果无显著差异。
