内侧副韧带损伤（MedialCo...

内侧副韧带损伤（MedialCo...The medial collateral ligament (MCL) extends from the medial epicondyle of the femur to below the medial condyle of the tibia.内侧副韧带(MCL)从股骨内侧髁延伸至胫骨内侧髁下。

The MCL is a static stabilizer composed of superficial (primary) and deep (secondary) portions that are restraints to valgus stress. The superficial MCL is the primary restraint tovalgus stress. The proximal attachment of the superficial MCL is at the posterior aspect of the medial femoral condyle. The distal attachment is at the metaphyseal attachment of the tibia, about 5 cm distal to the knee joint, lying beneath the Pes Anserinus. The deep MCL is the secondary restraint to valgus stress. The Deep MCL inserts directly into the edge of the tibial plateau and meniscus, and may be separated from the superficial layer by a bursa.MCL是一种由浅层(初级)和深层(次级)组成的静态稳定结构，对外翻应力起着抑制作用。

浅层MCL是外翻应力的主要抑制因素，近端附着在股骨内侧髁的后方。

远端附着在胫骨干骺端鹅足下，距膝关节远端约5厘米。

深层MCL是外翻应力的次要抑制因素，部分深层MCL 止于胫骨平台和半月板边缘，可能被粘液囊与浅层分离。

Superficial Ligament of the MCLthe Deep Ligament of the MCLThe joined Tendons of the sartorius, gracilus, and semitendinosis muscles cross on top of the lower part of the MCL. The Pes Anserine bursa is located anterior to the insertion of the MCL, into the tibia.缝匠肌、股薄肌和半腱肌的肌腱在MCL的下半部分交叉。

鹅足囊位于MCL连接胫骨前。

Function 功能The MCL’s primary function is to be a restraint to valgus stress.MCL的主要功能是抑制外翻应力。

Mechanism of Injury 损伤机制The MCL is the most commonly injured ligament of the knee. The typical mechanism of injury to the MCL is due to a valgus and external rotation force.MCL是最常见的膝关节韧带损伤。

MCL损伤的典型机制是外翻和外力的作用。

A direct blow to the knee also usually causes complete rupture of the MCL. The rupture may occur proximally or distally. However, tears of theproximal MCL have a greater healing rate. Tears of the distal MCL may not heal well, similar to the Stener lesion of the thumb.直接撞击膝通常也会导致MCL完全断裂，断裂可发生在近端或远端。

而近端MCL的撕裂容易愈合，远端MCL的撕裂可能愈合不好，类似于拇指的狭窄病变。

Associated Injuries 合并损伤About 95 % of associated injuries to the MCL include injury to the ACL. Rupture of the ACL causes anterolateral rotatory instability. The majority of MCL injuries that are associated with ACL injuries are Grade III complete ruptures. If this is the case, there will be no end point with valgus stress at 30 degrees or at 0 degrees of knee flexion.大约95%的MCL的合并损伤包括前交叉韧带(ACL)损伤。

ACL断裂可导致前外侧旋转不稳定，与ACL损伤相关的MCL损伤大多为III级完全断裂。

在这种情况下，不会出现在30度或0度屈膝时外翻应力的终点。

Meniscal tears are also associated with MCL injuries. Up to 5% of isolated MCL injuries are associated with meniscal tears. However, this is not a common injury.半月板撕裂也与MCL损伤有关，有5%的单发MCL损伤与半月板撕裂有关。

然而，这种伤并不常见。

Classification of MCL Sprains MCL损伤的分类There are three grade classifications of MCL injuries. Grade I injuries are considered sprains or stretch injuries, Grade II are partial tears of the MCL, and Grade III injuries are complete tears of the ligament with no end point with valgus stress at 30 and 0 degrees of knee flexion.MCL损伤分为三个等级。

I级损伤被认为是扭伤或过伸伤，II 级损伤是MCL的部分断裂，III级损伤是韧带的完全断裂，不会出现在30度或0度屈膝时外翻应力的终点。

Presentation 介绍If a patient presents with an MCL injury, they will recall a “popping” sensation in the knee. Their symptoms will include pain and tenderness in the area of the knee, usually higher than the joint line. The physical exam will reveal tenderness along the medial aspect of the knee, with ecchymosis and some knee effusion.如果患者出现MCL损伤，会有膝的“爆裂感”。

症状包括膝盖部位的疼痛和压痛，通常高于关节线。

体格检查将显示膝盖内侧压痛，伴有淤血和一些膝关节积液。

To test for an MCL injury, there will be a positive valgus stress test at 30 degrees of knee flexion, which indicates injury to the superficial MCL. Also, an opening around 1 cm indicated a complete tear of the MCL (Grade III). Finally, a positive valgus stress test a 0 degrees of knee extension indicates posteromedial capsule or cruciate ligament injury in addition to an MCL injury (combined injury).为了检测MCL损伤，将在膝关节屈曲30度时进行外翻应力测试，结果为阳性，表明MCL浅层损伤。

此外，有1cm的裂口表明MCL完全撕裂(III级)。

外翻应力测试阳性，膝关节伸展0度，表明后内侧包膜或交叉韧带损伤，以及MCL损伤(合并损伤)。

In the case of an MCL injury, other injuries (ACL, PCL, or medial meniscal) should always also be evaluated for.对于MCL损伤，要对其他损伤(ACL、PCL或内侧半月板)进行评估。

Imaging 影像Radiographs are usually normal, however, they may show calcification at the medial femoral site (Pellgrini-Stedia Syndrome). This would indicate an old injury. The calcification is due to chronic MCL injury at the medial femoral condyle insertion site.x线片通常显示正常，但有时可显示在股骨内侧部位钙化(Pellgrini-Stedia综合征)。

这说明以前有受伤史，钙化是由于股骨内侧髁的慢性MCL损伤所致。

In pediatric patients with a knee injury and suspected Salter fracture, stress views should be obtained to rule out a growth plate injury. There are more growth plate injuries than MCL injuries in pediatric patients. This is due to the fact that growth plates are weaker than ligaments. In this situation, MRI may be used instead of stress views.MRI is the study of choice for an MCL injury, as it identifies the location and extent of the MCL injury.对于患有膝关节损伤和疑似Salter骨折的小儿患者，应获得应力片以排除生长板损伤，小儿患者的生长板损伤多于MCL损伤。