Asavanapakas Panpaporn, Parinyakhup Wachiraphan, Boonriong Tanarat, Boonsri Pattira, Laohawiriyakamol Teeranan, Chuaychoosakoon Chaiwat
Departments of Orthopedics.
Radiology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.
Ann Med Surg (Lond). 2023 Apr 7;85(5):2014-2016. doi: 10.1097/MS9.0000000000000571. eCollection 2023 May.
A proximal deep medial collateral ligament (MCL) injury usually occurs in high-impact sports such as football or hockey. This injury is not common in low-energy trauma but the predisposing factor, in this case, was an osteophyte located next to the deep MCL ligament, which had likely caused degenerative changes to the ligament from chronic irritation, resulting in reduced strength of the ligament.
A 78-year-old Thai female presented with left knee pain 1 h after a low-energy trauma caused by a fall. The MRI showed deep MCL and medial meniscal root injuries, a nondisplaced lateral femoral condyle, and also revealed a large osteophyte near the midpart of the MCL, with a blunt persistent projection from the osteophyte pushing against the MCL where the injury was located. She was treated with a knee brace, a gait aid for walking, and analgesic pain control. Her symptoms gradually improved over the next few weeks.
If an osteophyte touches a ligament, it can cause degenerative changes to the ligament from chronic irritation, resulting in reducing the strength of the ligament and may be causing some degree of degenerative changes and tightening of the MCL in its at-rest state, resulting in an increased chance of injury when it is required to resist a sudden external force, even from a minor trauma.
When there is an osteophyte pushing against a ligament, there is an increased chance of ligament injury when even a minor trauma stresses that ligament.
近端深层内侧副韧带（MCL）损伤通常发生在足球或曲棍球等高冲击力运动中。这种损伤在低能量创伤中并不常见，但在此病例中，诱发因素是位于深层MCL韧带旁的骨赘，它可能因慢性刺激导致韧带发生退行性改变，从而使韧带强度降低。
一名78岁泰国女性在因跌倒导致低能量创伤1小时后出现左膝疼痛。MRI显示深层MCL和内侧半月板根部损伤，外侧股骨髁无移位，还显示在MCL中部附近有一个大的骨赘，骨赘有一个钝性的持续突起，顶在损伤部位的MCL上。她接受了膝关节支具治疗、助行器辅助行走以及止痛治疗。在接下来的几周里，她的症状逐渐改善。
如果骨赘接触到韧带，它会因慢性刺激导致韧带发生退行性改变，从而降低韧带强度，并可能在韧带静止状态下引起一定程度的退行性改变和MCL紧张，导致在需要抵抗突然外力时，即使是轻微创伤，韧带受伤的几率增加。
当有骨赘顶在韧带上时，即使是轻微创伤对该韧带造成压力，韧带受伤的几率也会增加。
