膝关节内侧副韧带及相关内侧结构的损伤

Injuries to the Medial Collateral Ligament and Associated Medial Structures of the Knee膝关节内侧副韧带及相关内侧结构的损伤Coen A. Wijdicks, PhD1, Chad J. Griffith, MD2, Steinar Johansen, MD3, Lars Engebretsen, MD, PhD3 and Robert F. LaPrade, MD, PhD4Investigation performed at the Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota, and the Oslo University Hospital and Faculty of Medicine, University of Oslo, Oslo, NorwayThe superficial medial collateral ligament and other medial knee stabilizers—i.e., the deep medial collateral ligament and the posterior oblique ligament—are the most commonly injured ligamentous structures of the knee.The main structures of the medial aspect of the knee are the proximal and distal divisions of the superficial medial collateral ligament, the meniscofemoral and meniscotibial divisions of the deep medial collateral ligament, and the posterior oblique ligament.Physical examination is the initial method of choice for the diagnosis of medial knee injuries through the application of a valgus load both at full knee extension and between 20° and 30° of knee flexion.Because nonoperative treatment has a favorable outcome, there is a consensus that it should be the first step in the management of acute isolated grade-III injuries of the medial collateral ligament or such injuries combined with an anterior cruciate ligament tear.If operative treatment is required, an anatomic repair or reconstruction is recommended.内侧副韧带浅层及其他内侧的膝关节稳定结构——即内侧副韧带深层和后斜韧带——是损伤最为多见的膝关节韧带结构。

膝关节内侧的主要结构包括内侧副韧带浅层的上段和下段，内侧副韧带深层的板股韧带和板胫韧带，以及后斜韧带。

在膝关节完全伸直以及屈曲20°-30°时施加外翻应力进行体格检查是诊断膝关节内侧损伤的首要方法。

由于非手术治疗通常可获得良好的疗效，一般认为新鲜的单纯III度内侧副韧带损伤或内侧副韧带合并前交叉韧带损伤时才考虑一期进行处理。

如必需进行手术治疗则推荐进行解剖修复或重建。

The understanding of the anatomy, biomechanics, and treatment of medial knee injuries continues to evolve. Quantitative techniques for the measurement of anatomic structures and biomechanical testing and digital radiography have improved anatomic definition of the severity of injuries. The development of new reconstruction techniques may lead to improved surgical outcomes.The superficial medial collateral ligament and other medial knee stabilizers—i.e., the deep medial collateral ligament and the posterior oblique ligament—are the most commonly injured ligamentous structures of the knee1-4. The incidence of injuries to these medial knee structures has been reported to be 0.24 per 1000 in the United States in any given year5 and to be twice as high in males (0.36 compared with 0.18 in females)5. The majority of medial knee ligament tears are isolated. These injuries occur predominantly in young individuals participating in sports activities, with the mechanism of injury involving valgus knee loading, external rotation, or a combined force vector occurring in such sports as skiing, ice hockey, and soccer, which require knee flexion6-8.对膝关节内侧损伤的解剖、生物力学和治疗的探索仍在不断推进，采用定量的方法测定解剖结构以及相关的生物力学试验和数字X线摄影（DR）使得损伤的严重程度从解剖角度而言更加确切，而由此创立的新的重建方法则可能进一步改善手术结果。

内侧副韧带浅层及其他内侧的膝关节稳定结构——即内侧副韧带深层和后斜韧带——是损伤最为多见的膝关节韧带结构1-4。

据报道5，在美国每年这样的膝关节内侧结构损伤的发生率约为每1000人0.24，而男性的发生率则是女性的两倍（0.36/0.18）。

大多数膝关节内侧结构损伤均为单发，这些损伤在参加体育运动的年轻患者中尤其多见，受伤机制主要包括膝关节外翻暴力，外旋或者在需要屈膝的运动中，如滑雪、冰球、足球等，多个方向的应力联合作用导致损伤6-8。

AnatomySuperficial Medial Collateral LigamentThe superficial medial collateral ligament, commonly called the tibial collateral ligament, is the largest structure of the medial aspect of the knee (Fig. 1, A). This structure consists of one femoral attachment and two tibial attachments9. Quantitative assessment has shown the femoral attachment to be oval and, on the average, 3.2 mm proximal and 4.8 mm posterior to the medial epicondyle. As the superficial medial collateral ligament courses distally, it has two tibial attachments. The proximal tibial attachment is primarily to soft tissue over the termination of the anterior arm of the semimembranosus tendon and is located an average of 12.2 mm distal to the tibial joint line9. The distal tibial attachment of the superficial medial collateral ligament is broad and is directly to bone at an average of 61.2 mm distal to the tibial joint line; it is located just anterior to the posteromedial crest of the tibia9. The two distinct tibial attachments have been reported to result in two distinct functioning divisions of the superficial medial collateral ligament10.解剖内侧副韧带浅层内侧副韧带浅层，通常称为胫侧副韧带，是膝关节内侧最大的结构（图1-A）。

该结构在股骨有一个附着点，在胫骨有两个附着点9，定量研究显示股骨附着点为卵圆形，平均距离内上髁上方3.2mm后方4.8mm。