Trofa David P, Sonnenfeld Julian J, Song Daniel J, Lynch T Sean
Department of Orthopaedics, New York Presbyterian, Columbia University Medical Center, New York, New York, U.S.A.
Arthrosc Tech. 2018 Aug 13;7(9):e921-e926. doi: 10.1016/j.eats.2018.05.001. eCollection 2018 Sep.
The medial collateral ligament (MCL) is the most commonly injured ligament of the knee. Given its extra-articular location, the MCL has great healing capacity such that the mainstay of treatment for most injuries remains conservative management. However, certain injury patterns place patients and athletes at risk of residual valgus laxity, which may require delayed surgical care and prolonged time out from sports. As such, identifying the specific injuries known to place patients at risk for failure with nonoperative management is of paramount importance. Although controversy remains regarding the optimal treatment of grade III MCL injuries, it is generally accepted that MCL ruptures from the distal tibia attachment require operative fixation. This technique article with accompanying video provides a detailed description of a technique for repairing the distal MCL attachment with suture augmentation. There are several advantages associated with an augmented direct repair including early, safe rehabilitation; prevention of valgus instability; and avoiding the comorbidities associated with a larger reconstruction.
内侧副韧带(MCL)是膝关节最常受伤的韧带。鉴于其关节外位置,MCL具有很强的愈合能力,因此大多数损伤的主要治疗方法仍是保守治疗。然而,某些损伤模式会使患者和运动员面临残留外翻松弛的风险,这可能需要延迟手术治疗并延长远离运动的时间。因此,识别已知会使患者面临非手术治疗失败风险的特定损伤至关重要。尽管对于III度MCL损伤的最佳治疗仍存在争议,但一般认为从胫骨远端附着点处断裂的MCL需要手术固定。这篇配有视频的技术文章详细描述了一种用缝线增强修复MCL远端附着点的技术。增强直接修复有几个优点,包括早期、安全的康复;预防外翻不稳定;以及避免与更大规模重建相关的合并症。