Patel Rohan R, Green Joshua S, Moran Jay, Santos Estevao, Medvecky Michael J
College of Medicine, State University of New York Upstate Medical University, Syracuse, New York, USA.
Frank H. Netter MD School of Medicine, Quinnipiac University, North Haven, Connecticut, USA.
Video J Sports Med. 2024 Jun 6;4(3):26350254241226723. doi: 10.1177/26350254241226723. eCollection 2024 May-Jun.
Injuries to the medial structures of the knee are common in multi-ligamentous knee injuries (MLKIs), which account for 0.02% of orthopedic injuries each year. The most common medial structure involved is the superficial medial collateral ligament (sMCL) with possible additional injury to the posterior oblique ligament (POL) and deep medial collateral ligament (dMCL). There has been little evidence for the superior management of these structures regarding the use of repair or reconstruction to reproduce overall knee function. Although reconstruction may provide more valgus stability postoperatively, the use of sMCL repair over reconstruction may be superior at reestablishing native anatomic alignment and kinematic relationships of the knee while also preserving proprioception and providing similar valgus stability.
Surgical repair of medial structures is typically indicated for third-degree injuries, bony avulsions, tibial plateau fracture, intra-articular entrapment of the end of the ligament (Stener-type lesions), or anteromedial stability. They are particularly indicated in the elite athlete who presents with excessive valgus laxity due to valgus knee loading, external rotation, or combined force vectors.
This surgical technique video demonstrates an open, medial-sided femoral and tibial approach to repair proximal and distal medial knee structures in the setting of MLKIs using case examples of a Stener lesion and a combined sMCL, POL, and medial patellofemoral ligament tears.
Repair of sMCL injuries has been reported to show favorable healing, knee stability, and function.
DISCUSSION/CONCLUSION: The use of fixation of the sMCL to its anatomical attachment points offers similar valgus stability and improved functional and patient-reported outcomes when compared with sMCL reconstruction.
The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
膝关节内侧结构损伤在多韧带损伤（MLKI）中很常见，每年占骨科损伤的0.02%。最常累及的内侧结构是浅层内侧副韧带（sMCL），可能还会合并后斜韧带（POL）和深层内侧副韧带（dMCL）损伤。关于使用修复或重建来恢复膝关节整体功能，这些结构的最佳治疗方法几乎没有证据支持。虽然重建术后可能提供更多的外翻稳定性，但与重建相比，使用sMCL修复在重建膝关节的原始解剖对线和运动学关系方面可能更具优势，同时还能保留本体感觉并提供相似的外翻稳定性。
内侧结构的手术修复通常适用于三度损伤、骨撕脱、胫骨平台骨折、韧带末端关节内卡压（斯滕纳氏型损伤）或前内侧稳定性损伤。对于因膝关节外翻负荷、外旋或合力向量而出现过度外翻松弛的精英运动员，尤其适用。
本手术技术视频展示了一种开放的、内侧股骨和胫骨入路，用于在MLKI情况下修复膝关节近端和远端内侧结构，使用斯滕纳氏损伤以及sMCL、POL和内侧髌股韧带联合撕裂的病例。
据报道，sMCL损伤的修复显示出良好的愈合、膝关节稳定性和功能。
讨论/结论：与sMCL重建相比，将sMCL固定到其解剖附着点可提供相似的外翻稳定性，并改善功能和患者报告的结果。
作者证明已获得本出版物中出现的任何患者的同意。如果个体可能被识别，作者已随本投稿附上患者的豁免声明或其他书面批准形式以供发表。
