Krukhaug Y, Mølster A, Rodt A, Strand T
Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway.
Knee Surg Sports Traumatol Arthrosc. 1998;6(1):21-5. doi: 10.1007/s001670050067.
Between 1982 and 1994 28 patients were treated for acute lateral knee ligament injuries; 25 patients, with a median age of 25.5 (range 16-75) years at injury, appeared for follow-up. Seven patients had isolated injury of the lateral collateral ligament/capsular structures, the remaining 19 patients had concomitant ligament injuries in the knee. Eight patients were treated conservatively, 1 with plaster immobilization and 7 with early mobilization. Eighteen patients underwent surgery, 17 of these within 3 weeks of injury. Repair/reconstruction of the cruciate ligaments was done at the same time as the lateral collateral ligament repair in 10 patients. At follow-up after a median of 7.5 years (range 6 months to 13 years), 11 had no varus instability, 7 had 1+, 5 had 2+, and 2 patients had 3+ varus instability. All patients with a final result of 2+ or 3+ had combined ligament injuries. The surgically treated lateral collateral ligament injuries all had a primary instability of 2+ or more. These patients showed an improvement in varus instability from a mean of 2.83+ preoperatively to a mean of 1.17+ postoperatively. Two-thirds of the surgically treated patients were stable or had a 1+ instability at follow-up. One conservatively treated patient with a 2+ varus instability and 1 with 1+ showed no improvement. Five conservatively treated patients with initial varus instability of 1+ were stable at follow-up. One patient with a 1+ varus instability had anterior cruciate ligament (ACL) rupture. He had a primary ACL reconstruction without lateral repair. He had no varus instability at follow-up. Our study supports the notion that operation performed at an early stage in fresh injuries with a varus instability of 2+ or more gives improved stability as a final result. Conservative treatment may not be expected to give an improved stability, but is sufficient in mild varus instability (1+) without additional cruciate ligament injuries.
1982年至1994年间，28例患者接受了急性膝关节外侧韧带损伤治疗；25例患者前来随访，受伤时的中位年龄为25.5岁（范围16 - 75岁）。7例患者为单纯外侧副韧带/关节囊结构损伤，其余19例患者膝关节存在合并韧带损伤。8例患者接受保守治疗，1例采用石膏固定，7例采用早期活动。18例患者接受了手术治疗，其中17例在受伤后3周内进行手术。10例患者在修复外侧副韧带的同时进行了交叉韧带的修复/重建。随访时，中位时间为7.5年（范围6个月至13年），11例患者无内翻不稳，7例为1+，5例为2+，2例患者为3+内翻不稳。最终结果为2+或3+的所有患者均有合并韧带损伤。手术治疗的外侧副韧带损伤患者初始不稳均为2+或更严重。这些患者的内翻不稳从术前平均2.83+改善至术后平均1.17+。三分之二接受手术治疗的患者在随访时稳定或为1+不稳。1例接受保守治疗且内翻不稳为2+的患者和1例为1+的患者无改善。5例初始内翻不稳为1+的保守治疗患者在随访时稳定。1例内翻不稳为1+的患者发生了前交叉韧带（ACL）断裂。他接受了初次ACL重建但未进行外侧修复。随访时他无内翻不稳。我们的研究支持这样的观点，即对于新鲜损伤且内翻不稳为2+或更严重的患者早期进行手术，最终可改善稳定性。保守治疗可能无法改善稳定性，但对于轻度内翻不稳（1+）且无额外交叉韧带损伤的情况是足够的。
