Hughston J C
Hughston Orthopaedic Clinic, Columbus, Georgia.
J Bone Joint Surg Am. 1994 Sep;76(9):1328-44. doi: 10.2106/00004623-199409000-00008.
Forty-one of fifty patients (fifty knees) who had had a repair of an acute tear of the medial ligaments, a procedure in which repair of the posterior oblique ligament and the semimembranosus complex was emphasized, were re-evaluated after an average duration of follow-up of twenty-two years (range, eighteen to thirty years). The ages of the patients at the time of the injury had ranged from fifteen to twenty-one years. In twenty-four of the forty-one knees, the anterior cruciate ligament had been torn. In seventeen of these knees, the torn ligament had been debrided; in six others, which had had avulsion of a bone fragment or a terminal tear, the ligament had been repaired with absorbable sutures; and in the remaining knee, the repaired anterior cruciate ligament had been augmented. Four patients had had a pes anserinus transfer to supplement the medial repair. The medial meniscus had been intact or repaired in twenty-five of the forty-one knees and had been removed from the remaining sixteen. The lateral meniscus had been retained in thirty-nine knees and removed from two. Postoperatively, all knees had been immobilized for six weeks in 60 degrees of flexion by means of a plaster cast. This had not caused lasting loss of motion, persistent muscle atrophy, or clinically demonstrable deterioration of the articular cartilage. In the twenty-four knees that had had a tear of the anterior cruciate ligament, the rates of instability, meniscal injury, and deterioration of the joint had not increased since the time of treatment, compared with those in the knees with an intact ligament, even though repair and augmentation of this ligament had not been performed (except in one patient, in whom it was unsuccessful). Thirty-eight patients had good stability and a normal range of motion, as well as little or no muscle atrophy. Radiographic changes were slight or absent in all but four knees. Most patients had maintained a high level of physical fitness and recreational athletic activity. There were three failures of treatment (7 per cent). This previously described treatment of acute tears of the medial ligaments, with or without an associated tear of the anterior cruciate ligament, provides good long-term results and is still recommended.
五十例（五十个膝关节）急性内侧韧带撕裂患者接受了修复手术，该手术强调对后斜韧带和半膜肌复合体进行修复。在平均随访二十二年（范围为十八至三十年）后，对其中四十一例患者进行了重新评估。受伤时患者的年龄在十五至二十一岁之间。在这四十一例膝关节中，有二十四例前交叉韧带撕裂。在其中十七例膝关节中，撕裂的韧带已被清创；在另外六例有骨块撕脱或终末撕裂的膝关节中，韧带用可吸收缝线进行了修复；在其余一例膝关节中，修复后的前交叉韧带进行了增强。四名患者进行了鹅足腱转移以辅助内侧修复。四十一例膝关节中有二十五例内侧半月板完整或已修复，其余十六例已切除。外侧半月板在三十九例膝关节中得以保留，两例被切除。术后，所有膝关节均通过石膏固定在60度屈曲位六周。这并未导致持久的活动丧失、持续性肌肉萎缩或关节软骨的临床可证实的退变。在二十四例有前交叉韧带撕裂的膝关节中，自治疗以来，与韧带完整的膝关节相比，不稳定、半月板损伤和关节退变的发生率并未增加，尽管该韧带未进行修复和增强（除一例患者手术未成功外）。三十八例患者稳定性良好，活动范围正常，肌肉萎缩轻微或无萎缩。除四例膝关节外，所有膝关节的影像学改变均轻微或无改变。大多数患者保持了较高的身体素质和娱乐性体育活动水平。有三例治疗失败（7%）。先前描述的急性内侧韧带撕裂的治疗方法，无论是否伴有前交叉韧带撕裂，均能提供良好的长期效果，目前仍被推荐。
