Department of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing, China.
Medical School of Nankai University, Tianjin, China.
Orthop Surg. 2020 Dec;12(6):1784-1791. doi: 10.1111/os.12818. Epub 2020 Oct 16.
To describe the technique of primary repair of medial collateral ligament (MCL) insufficiency using a screw and rectangular spiked washer in a case series of 14 patients.
Fourteen patients undergoing MCL repair by a screw and rectangular spiked washer during TKA between March 2018 and March 2019 were retrospectively reviewed. Among them, half injuries were avulsion of the femoral origin, and the other half were MCL laxity. There were 12 women and two men included in the study, with an average age of 63.6 years (range, 49-79 years) at the time of surgery. This series were followed up with a focus on range of motion (ROM), coronal alignment, Hospital for Special Surgery (HSS) knee scores, their subjective sense of joint instability, and related complications. At the last follow-up, function of the MCL was assessed by manually applying a valgus stress to the knee at both 0° and 30° of knee flexion.
The mean follow-up time for all patients was 15.6 months (range, 13-20 months). Repair of the MCL was successful in all patients. ROM improved from a mean of 70.7° ± 35.1° before surgery to 103.9° ± 6.8° at latest follow-up (P = 0.001). All patients were able to perform a half squat easily, but none were able to do full squatting. The mean preoperative HSS score was 43.6 ± 13.4 and increased to a mean of 85.6 ± 3.8 postoperatively (P < 0.001). The femorotibial angle improved from a mean of -3.22° ± 9.47° before surgery to a mean of 5.16° ± 3.14° at the final follow-up (P = 0.006). At the time of final follow-up, no patient required revision and manipulation under anesthesia following the index arthroplasty. No radiolucencies or migration were observed in association with the knee prostheses. No displacement of the screw and rectangular spiked washer was found. There were no clinical complications. No patient reported subjective instability of the knee. Upon physical examination, no patient was found to have laxity in the coronal plane in either 30° of flexion or full extension.
The screw and rectangular spiked washer is a simple and effective method for treating MCL sufficiency in TKA, and a study with a larger cohort and extended follow-up is requisite to claim its role in preventing coronal instability and component failure.
通过对 14 例患者的病例系列研究，描述使用螺钉和矩形带刺垫圈修复内侧副韧带（MCL）不足的技术。
回顾 2018 年 3 月至 2019 年 3 月期间接受 TKA 时使用螺钉和矩形带刺垫圈进行 MCL 修复的 14 例患者。其中，一半损伤为股骨起点撕脱，另一半为 MCL 松弛。研究包括 12 名女性和 2 名男性，手术时的平均年龄为 63.6 岁（范围，49-79 岁）。本系列重点随访了运动范围（ROM）、冠状对线、特种外科医院（HSS）膝关节评分、关节不稳定的主观感觉以及相关并发症。末次随访时，通过在膝关节 0°和 30°屈曲时手动施加外翻应力来评估 MCL 的功能。
所有患者的平均随访时间为 15.6 个月（范围，13-20 个月）。所有患者的 MCL 修复均成功。ROM 从术前平均 70.7°±35.1°改善至末次随访时的 103.9°±6.8°（P=0.001）。所有患者均能轻松完成半蹲，但均无法完成全蹲。术前 HSS 评分平均为 43.6±13.4，术后平均增加至 85.6±3.8（P<0.001）。股胫角从术前平均-3.22°±9.47°改善至末次随访时的平均 5.16°±3.14°（P=0.006）。末次随访时，无患者需要对索引关节置换进行翻修和关节内麻醉下手法复位。未观察到与膝关节假体相关的放射性透明或迁移。未发现螺钉和矩形带刺垫圈的移位。无临床并发症。无患者报告膝关节不稳定的主观感觉。体格检查时，在 30°屈曲或完全伸展时，均未发现冠状面松弛。
螺钉和矩形带刺垫圈是治疗 TKA 中 MCL 不足的一种简单有效的方法，但需要更大的队列和更长的随访时间来证明其在预防冠状面不稳定和组件失效方面的作用。
