Moatshe Gilbert, Vap Alexander R, Getgood Alan, LaPrade Robert F, Engebretsen Lars
Orthopaedic Clinic, Oslo University Hospital and University of Oslo, Oslo, Norway.
Oslo Sports Trauma Research Center, The Norwegian School of Sports Sciences, Oslo, Norway.
J Knee Surg. 2020 May;33(5):431-439. doi: 10.1055/s-0039-3402768. Epub 2020 Feb 19.
Multiligament knee injuries (MLKI) are complex and challenging to treat. The posteromedial corner (PMC) structures are commonly torn in MLKI. A thorough and systematic evaluation is imperative to avoid a missed diagnosis and for planning treatment. With several structures injured, the treatment method (operative vs. nonoperative, repair vs. reconstruction), availability of allografts, timing of surgery, and rehabilitation are some of the factors that have to be considered in the decision-making. Persistent valgus instability because of untreated or not healed medial collateral ligament (MCL) tears will increase graft forces on the cruciate ligament grafts, thus increasing the risk of reconstruction graft failure. In recent years, there has been a growing body of literature on the anatomy and biomechanics of the medial structures that has aided in the development of biomechanically and clinically validated anatomic PMC reconstructions. Despite good healing potential of the MCL, in MLKI, surgical treatment is recommended for grade III PMC injuries to aid early rehabilitation and reduce the risk of surgical failure. Several studies have reported satisfactory outcomes after surgical treatment of MLKI involving the medial side. Early functional rehabilitation is imperative to reduce the risk of arthrofibrosis.
膝关节多韧带损伤（MLKI）治疗起来复杂且具有挑战性。后内侧角（PMC）结构在MLKI中常发生撕裂。进行全面系统的评估对于避免漏诊以及规划治疗至关重要。由于多个结构受损，治疗方法（手术治疗与非手术治疗、修复与重建）、同种异体移植物的可获得性、手术时机以及康复等都是决策时必须考虑的因素。因内侧副韧带（MCL）撕裂未治疗或未愈合导致的持续性外翻不稳定会增加交叉韧带移植物上的移植物受力，从而增加重建移植物失败的风险。近年来，关于内侧结构的解剖学和生物力学的文献越来越多，这有助于开发经生物力学和临床验证的解剖学PMC重建术。尽管MCL具有良好的愈合潜力，但在MLKI中，对于III级PMC损伤，建议进行手术治疗以促进早期康复并降低手术失败的风险。多项研究报告了涉及内侧的MLKI手术治疗后的满意结果。早期功能康复对于降低关节纤维化风险至关重要。
