Inagawa Miyu, Sanada Takaki, Iwaso Hiroshi
Department of Sports Orthopedic Surgery, Kanto Rosai Hospital, 1-1 Kizuki Sumiyoshi-cho, Nakahara-ku, Kawasaki city, Kanagawa-pref, Japan.
Asia Pac J Sports Med Arthrosc Rehabil Technol. 2020 Jun 9;22:1-4. doi: 10.1016/j.asmart.2020.05.002. eCollection 2020 Oct.
MRI did not detect any abnormality in the medial meniscus besides high-intensity changes at the meniscofemoral portion of the deep medial collateral ligament. Although pure valgus stress test proved no medial joint widening at 0° and 30°, when an examiner applied knee valgus and tibial external rotation force, the patient experienced pain in the anteromedial knee joint that coincided with their refractory symptoms in individual specific activity. Arthroscopy investigation confirmed that the anterior to middle segment of the medial meniscus had excessively slid into the central direction by a probe-drawing manoeuvre; synchronous meniscal movement in the valgus and external rotation test was also observed. After arthroscopic meniscal suture to the lesion had suppressed the abnormal meniscal movement, the patients' refractory anteromedial symptoms disappeared immediately. From their common history of medial collateral injury and the high intensity at the deep medial collateral ligament, we assumed that chronic deep medial collateral ligament impairment sustained the hypermobility of the medial meniscus. Arthroscopic confirmation of hypermobility led to definitive treatment of a simple meniscal suture. Painful deep MCL injuries with hypermobile medial arthroscopic findings are not a rare phenomenon as previously assumed; however, surgeons often fail to recognize its latent clinical features.
除了内侧副韧带深层半月板股骨部分出现高强度改变外，MRI未检测到内侧半月板有任何异常。尽管单纯外翻应力试验在0°和30°时未显示内侧关节增宽，但当检查者施加膝关节外翻和胫骨外旋力时，患者在膝关节前内侧出现疼痛，这与他们在特定个体活动中的难治性症状相符。关节镜检查证实，通过探针牵拉操作，内侧半月板前中段过度向中央方向滑动；在外翻和外旋试验中也观察到半月板同步运动。在对病变进行关节镜半月板缝合抑制了半月板异常运动后，患者难治性的前内侧症状立即消失。从他们共同的内侧副韧带损伤病史以及内侧副韧带深层的高强度改变来看，我们推测慢性内侧副韧带深层损伤维持了内侧半月板的过度活动。关节镜证实的过度活动导致了简单半月板缝合的确定性治疗。伴有关节镜下内侧过度活动表现的疼痛性深层内侧副韧带损伤并非如之前所认为的那样罕见；然而，外科医生往往未能认识到其潜在的临床特征。
