急性前交叉韧带损伤合并内侧副韧带损伤的治疗选择

Treatment of acute anterior cruciate and medial collateral ligament injuries of knee

目的探讨急性前交叉韧带(ACL)损伤合并内侧副韧带(MCL)损伤的治疗时机及方法。方法 2002年12月-2008年10月,治疗急性ACL损伤合并MCL损伤58例。MCL损伤Ⅰ度7例,Ⅱ度25例,Ⅲ度26例。MCLⅠ、Ⅱ度损伤共32例经3-4周制动,待关节活动功能恢复后行ACL重建;Ⅲ度损伤7例经制动6周,伤后9-10周行ACL重建。19例伤后两周内行ACL重建,术后在伸直位和屈膝30°位用支具制动6-8周,11例阴性,8例阳性,6例有后内侧关节囊撕裂,于损伤部位小切口用缝合铆钉原位修复后内侧结构,术后用支具制动6-8周。结果平均随访15月(6-34月),Ⅰ-Ⅱ度损伤32例外翻应力试验阴性,前抽屉试验(+)2例,术后Lysholm评分91.2。18例MCLⅢ度损伤保守治疗,外翻应力试验Ⅰ度3例、Ⅱ度1例,前抽屉试验(+)2例、(++)1例,术后Lysholm评分86.5。MCLⅢ度损伤8例经手术修复治疗,外翻应力试验Ⅰ度2例,前抽屉试验(+)1例,术后Lysholm评分89.3。结论急性ACL损伤合并Ⅲ度MCL损伤应早期手术,ACL重建后外翻应力试验不稳者需早期手术修复MCL。

Objective To study the treatment modalities for acute anterior cruciate ligament（ACL） and medial collateral ligament（MCL） injuries.Methods Fifty-eight patients with acute ACL and MCL injuries（including gradeⅠin 7,gradeⅡin 25 and grade Ⅲ in 26 cases） were treated in our department from December 2002 to October 2008.ACL was reconstructed when the knee function was recovered in 32 patients with gradeⅠand gradeⅡMCL injury after they were immobilized for 3-4 weeks,in 7 patients with gradeⅢMCL injury after they were immobilized for 6 weeks,in 19 patients with gradeⅢMCL injury after they were immobilized for 2 weeks.Valgus stress testing for full extension and 300 of flexion was negative in 11 patients and positive in 8 patients after they were immobilized for 6-8 weeks.Posterior knee capsule tear in 6 patients was repaired with its posteromedial structure immobilized for 6-8 weeks using suture anchor techniques.Results The patients were followed up for 15 months（range 6-34 months）.Thirty-two patients with gradesⅠandⅡtears were negative for Valgus stress testing,and 2 patients were（＋） for anterior drawer test with a Lysholm score of 91.2 after operation.Eighteen patients with gradesⅢtear received conservative treatment with degreesⅠandⅡof Valgus stress testing in 3 and 1 patient,respectively.Anterior drawer test was（＋） and（＋＋） in 2 and 1 patient,respectively,with a Lysholm score of 86.5 after operation.Eight patients with gradeⅢtears were treated with suture anchor with degreeⅠof Valgus stress testing in 2 patients,（＋） of anterior drawer test in 1 patient,and a Lysholm score of 89.3 after operation.Conclusion Early operation should be performed for acute ACL and MCL injuries.MCL injuries should be repaired after ACL reconstruction if its Valgus stress testing is instable.