Floyd Edward R, Tollefson Luke V, Falaas Kari L, Ebert Nicholas J, Struyk Griffin D, Carlson Gregory B, LaPrade Robert F
Twin Cities Orthopedics, Edina, Minnesota, USA.
Georgetown University School of Medicine, Washington, DC, USA.
Orthop J Sports Med. 2025 Feb 6;13(2):23259671241302095. doi: 10.1177/23259671241302095. eCollection 2025 Feb.
A paucity of data exists to guide surgical management of the medial collateral ligament (MCL). High-grade MCL injuries are often treated with surgical repair or reconstruction; however, guidelines for choosing one or the other technique remain unclear.
To systematically review the literature to determine whether repair versus reconstruction of the MCL in multiligament knee injuries results in improved outcomes.
Systematic review; Level of evidence, 4.
A systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed between January 1980 and January 2024. The initial search yielded 85 studies. Exclusion criteria included <2 years of follow-up, technical/case reports, articular fractures, and undifferentiated multiligament results. Extracted data included patient characteristics, ligaments injured, chronicity of injury, incidence of failure, arthrofibrosis, patient-reported outcome scores, and stress radiographs. Failure was included as reported by studies and included clinical failure (graft laxity), failure of the repair or reconstruction, or the need for a lysis of adhesions or manipulation under anesthesia. Statistical analysis included unpaired tests and chi-square goodness-of-fit tests.
In total, 30 studies were included in the final analysis (458 repairs, 590 reconstructions). The mean patient age for the repair group was 33.1 years (SD, 5.11 years) with a mean follow-up time of 4.2 years (SD, 2.59 years) and the mean patient age for the reconstruction group was 33.4 years (SD, 4.40 years) with a mean follow-up time of 3.1 years (SD, 1.41 years). There was no significant difference found between the reconstruction and repair groups of the MCL for the Lysholm, subjective International Knee Documentation Committee, Tegner scores, and stress radiographs ( > .05). Arthrofibrosis rates for MCL reconstruction (5.4%) were determined to be significantly less than those within the repair group (11.6%) ( < .001). Failure rates for MCL reconstruction (2.9%) were determined to be significantly less when compared with the MCL repair group (5.7%) ( = .024). Anterior cruciate ligament (ACL) failure rates for MCL reconstruction (0.2%) were determined to be significantly less than those within the repair group (2.3%) ( = .002).
This systematic review showed that MCL reconstructions demonstrated decreased postoperative arthrofibrosis compared with MCL repairs across all studies. Studies reporting on failures reported decreased clinical failures and ACL graft failures in the setting of concomitant ACL and MCL reconstructions compared with MCL repairs. Future randomized controlled studies are needed to further determine the best surgical technique for patients with multiligament knee injuries.
目前缺乏指导内侧副韧带（MCL）手术治疗的数据。高级别MCL损伤通常采用手术修复或重建治疗；然而，选择其中一种技术的指南仍不明确。
系统回顾文献，以确定在多韧带膝关节损伤中，MCL修复与重建是否能带来更好的治疗效果。
系统回顾；证据级别，4级。
根据系统评价和Meta分析的首选报告项目指南，在1980年1月至2024年1月期间进行了系统回顾。初步检索得到85项研究。排除标准包括随访时间不足2年、技术/病例报告、关节骨折以及未区分的多韧带损伤结果。提取的数据包括患者特征、损伤的韧带、损伤的慢性程度、失败发生率、关节纤维化、患者报告的结局评分以及应力X线片。失败定义为研究报告的情况，包括临床失败（移植物松弛）、修复或重建失败，或需要进行粘连松解或麻醉下手法操作。统计分析包括非配对t检验和卡方拟合优度检验。
最终分析纳入了30项研究（458例修复，59例重建）。修复组患者的平均年龄为33.1岁（标准差，5.11岁），平均随访时间为4.2年（标准差，2.59年）；重建组患者的平均年龄为33.4岁（标准差，4.40岁），平均随访时间为3.1年（标准差，1.41年）。在Lysholm评分、主观国际膝关节文献委员会评分、Tegner评分和应力X线片方面，MCL重建组和修复组之间未发现显著差异（P>.05）。MCL重建的关节纤维化发生率（5.4%）显著低于修复组（11.6%）（P<.001）。MCL重建的失败率（2.9%）显著低于MCL修复组（5.7%）（P=.024）。MCL重建的前交叉韧带（ACL）失败率（0.2%）显著低于修复组（2.3%）（P=.002）。
本系统回顾表明，在所有研究中，与MCL修复相比，MCL重建术后关节纤维化减少。报告失败情况的研究表明，与MCL修复相比，在同时进行ACL和MCL重建的情况下，临床失败和ACL移植物失败减少。未来需要进行随机对照研究，以进一步确定多韧带膝关节损伤患者的最佳手术技术。
