Von Rehlingen-Prinz Fidelius, Leiderer Miriam, Dehoust Julius, Dust Tobias, Kowald Birgitt, Frosch Karl-Heinz, Izadpanah Kaywan, Henes Frank Oliver, Krause Matthias
Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
Department of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Hospital Hamburg, Bergedorfer Str. 10, 21033, Hamburg, Germany.
Sports Med Open. 2023 Aug 8;9(1):70. doi: 10.1186/s40798-023-00611-6.
The combined injury of the medial collateral ligament complex and the anterior cruciate ligament (ACL) is the most common two ligament injury of the knee. Additional injuries to the medial capsuloligamentous structures are associated with rotational instability and a high failure rate of ACL reconstruction. The study aimed to analyze the specific pattern of medial injuries and their associated risk factors, with the goal of enabling early diagnosis and initiating appropriate therapeutic interventions, if necessary.
Between January 2017 and December 2018, 151 patients with acute ACL ruptures with a mean age of 32 ± 12 years were included in this study. The MRIs performed during the acute phase were analyzed by four independent investigators-two radiologists and two orthopedic surgeons. The trauma impact on the posterolateral tibial plateau and associated injuries to the medial complex (POL, dMCL, and sMCL) were examined and revealed an injury to the medial collateral ligament complex in 34.4% of the patients. The dMCL was the most frequently injured structure (92.2%). A dMCL injury was significantly associated with an increase in trauma severity at the posterolateral tibial plateau (p < 0.02) and additional injuries to the sMCL (OR 4.702, 95% CL 1.3-133.3, p = 0.03) and POL (OR 20.818, 95% CL 5.9-84.4, p < 0.0001). Isolated injuries to the sMCL were not observed. Significant risk factors for acquiring an sMCL injury were age (p < 0.01) and injury to the lateral meniscus (p < 0.01).
In about one-third of acute ACL ruptures the medial collateral ligament complex is also injured. This might be associated with an increased knee laxity as well as anteromedial rotational instability. Also, this might be associated with an increased risk for failure of revision ACL reconstruction. In addition, we show risk factors and predictors that point to an injury of medial structures and facilitate their diagnosis. This should help physicians and surgeons to precisely diagnose and to assess its scope in order to initiate proper therapies. With this in mind, we would like to draw attention to a frequently occurring combination injury, the so-called "unlucky triad" (ACL, MCL, and lateral meniscus). Level of evidence Level III Retrospective cohort study.
内侧副韧带复合体与前交叉韧带（ACL）联合损伤是膝关节最常见的双韧带损伤。内侧囊韧带结构的额外损伤与旋转不稳定及ACL重建的高失败率相关。本研究旨在分析内侧损伤的具体模式及其相关危险因素，以期实现早期诊断并在必要时启动适当的治疗干预措施。
2017年1月至2018年12月期间，本研究纳入了151例急性ACL断裂患者，平均年龄为32±12岁。急性期进行的MRI由四位独立研究者——两位放射科医生和两位骨科医生进行分析。检查了创伤对胫骨后外侧平台的影响以及内侧复合体（后外侧关节囊韧带、深层内侧副韧带和浅层内侧副韧带）的相关损伤，结果显示34.4%的患者存在内侧副韧带复合体损伤。深层内侧副韧带是最常受伤的结构（92.2%）。深层内侧副韧带损伤与胫骨后外侧平台创伤严重程度增加（p<0.02）以及浅层内侧副韧带（比值比4.702，95%可信区间1.3 - 133.3，p = 0.03）和后外侧关节囊韧带（比值比20.818，95%可信区间5.9 - 84.4，p<0.0001）的额外损伤显著相关。未观察到浅层内侧副韧带的孤立损伤。获得浅层内侧副韧带损伤的显著危险因素是年龄（p<0.01）和外侧半月板损伤（p<0.01）。
在约三分之一的急性ACL断裂中，内侧副韧带复合体也会受伤。这可能与膝关节松弛增加以及前内侧旋转不稳定有关。此外，这可能与翻修ACL重建失败风险增加有关。此外，我们展示了指向内侧结构损伤并有助于其诊断的危险因素和预测因素。这应有助于医生和外科医生准确诊断并评估其范围，以便启动适当的治疗。考虑到这一点，我们想提请注意一种经常发生的联合损伤，即所谓的“不幸三联征”（ACL、MCL和外侧半月板）。证据水平 III级回顾性队列研究。
