“孤立”前交叉韧带撕裂中深层及浅层内侧副韧带损伤的高发率：一种长期被忽视的损伤。
High incidence of superficial and deep medial collateral ligament injuries in 'isolated' anterior cruciate ligament ruptures: a long overlooked injury.
机构信息
Department of Trauma and Orthopaedics, Chelsea and Westminster Hospital, Chelsea and Westminster NHS Foundation Trust, London, UK.
Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany.
出版信息
Knee Surg Sports Traumatol Arthrosc. 2022 Jan;30(1):167-175. doi: 10.1007/s00167-021-06514-x. Epub 2021 Mar 4.
PURPOSE
In anterior cruciate ligament (ACL) injuries, concomitant damage to peripheral soft tissues is associated with increased rotatory instability of the knee. The purpose of this study was to investigate the incidence and patterns of medial collateral ligament complex injuries in patients with clinically 'isolated' ACL ruptures.
METHODS
Patients who underwent ACL reconstruction for complete 'presumed isolated' ACL rupture between 2015 and 2019 were retrospectively included in this study. Patient's characteristics and intraoperative findings were retrieved from clinical and surgical documentation. Preoperative MRIs were evaluated and the grade and location of injuries to the superficial MCL (sMCL), dMCL and the posterior oblique ligament (POL) recorded. All patients were clinically assessed under anaesthesia with standard ligament laxity tests.
RESULTS
Hundred patients with a mean age of 22.3 ± 4.9 years were included. The incidence of concomitant MCL complex injuries was 67%. sMCL injuries occurred in 62%, dMCL in 31% and POL in 11% with various injury patterns. A dMCL injury was significantly associated with MRI grade II sMCL injuries, medial meniscus 'ramp' lesions seen at surgery and bone oedema at the medial femoral condyle (MFC) adjacent to the dMCL attachment site (p < 0.01). Logistic regression analysis identified younger age (OR 1.2, p < 0.05), simultaneous sMCL injury (OR 6.75, p < 0.01) and the presence of bone oedema at the MFC adjacent to the dMCL attachment site (OR 5.54, p < 0.01) as predictive factors for a dMCL injury.
CONCLUSION
The incidence of combined ACL and medial ligament complex injuries is high. Lesions of the dMCL were associated with ramp lesions, MFC bone oedema close to the dMCL attachment, and sMCL injury. Missed AMRI is a risk factor for ACL graft failure from overload and, hence, oedema in the MCL (especially dMCL) demands careful assessment for AMRI, even in the knee lacking excess valgus laxity. This study provides information about specific MCL injury patterns including the dMCL in ACL ruptures and will allow surgeons to initiate individualised treatment.
LEVEL OF EVIDENCE
III.
目的
在前交叉韧带（ACL）损伤中，周围软组织的并发损伤与膝关节的旋转不稳定性增加有关。本研究的目的是探讨临床上“孤立”ACL 断裂患者中内侧副韧带复合体损伤的发生率和模式。
方法
回顾性纳入 2015 年至 2019 年间接受 ACL 重建的完全“假定孤立”ACL 断裂患者。从临床和手术记录中检索患者特征和术中发现。评估术前 MRI，并记录浅层内侧副韧带（sMCL）、深层内侧副韧带（dMCL）和后斜韧带（POL）的损伤程度和位置。所有患者均在麻醉下进行临床评估，采用标准的韧带松弛试验。
结果
本研究共纳入 100 例平均年龄为 22.3±4.9 岁的患者。并发 MCL 复合体损伤的发生率为 67%。sMCL 损伤发生率为 62%，dMCL 损伤发生率为 31%，POL 损伤发生率为 11%，损伤模式各不相同。dMCL 损伤与 MRI Ⅱ级 sMCL 损伤、术中发现的内侧半月板“斜坡”病变以及 dMCL 附着处邻近股骨内侧髁（MFC）的骨水肿显著相关（p<0.01）。Logistic 回归分析确定年龄较小（OR 1.2，p<0.05）、同时存在 sMCL 损伤（OR 6.75，p<0.01）和 dMCL 附着处邻近 MFC 的骨水肿（OR 5.54，p<0.01）是 dMCL 损伤的预测因素。
结论
ACL 合并内侧韧带复合体损伤的发生率较高。dMCL 损伤与斜坡病变、MFC 骨水肿靠近 dMCL 附着处以及 sMCL 损伤有关。错过 AMRI 是 ACL 移植物因超负荷而失效的危险因素，因此即使在没有过度外翻松弛的膝关节中，MCL（尤其是 dMCL）的水肿也需要仔细评估 AMRI。本研究提供了 ACL 断裂中特定 MCL 损伤模式的信息，包括 dMCL，这将使外科医生能够开始个体化治疗。
证据水平
III。
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