前交叉韧带自体肌腱重建联合全关节镜下修复内侧副韧带损伤与传统切开修复的临床疗效对比

doi:10.13418/j.issn.1001-165x.2025.6.13

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中国临床解剖学杂志 ›› 2025, Vol. 43 ›› Issue (6) : 703-709. DOI: 10.13418/j.issn.1001-165x.2025.6.13

临床研究

前交叉韧带自体肌腱重建联合全关节镜下修复内侧副韧带损伤与传统切开修复的临床疗效对比

吴李闯，叶奕亨，刘彩龙*

作者信息 +

Comparison of clinical efficacy between autologous anterior cruciate ligament reconstruction combined with arthroscopic repair of medial collateral ligament injury and traditional open repair

Wu Lichuang, Ye Yiheng, Liu Cailong*

Author information +

文章历史 +

摘要

目的对比前交叉韧带自体肌腱重建联合全关节镜下修复内侧副韧带损伤与传统切开修复的临床疗效。方法选取 2018 年 1 月至 2023年 1 月于我院就诊的 64 例前交叉韧带损伤合并内侧副韧带损伤患者，分为前交叉韧带自体肌腱重建联合内侧副韧带全关节镜下修复组与切开修复组各 32 例。比较两组术后并发症发生率，以及术后 6 月、12 月和24月的膝关节功能评分（Lysholm 评分、Tegner 评分、IKDC 评分）和膝关节稳定性。结果全关节镜下修复组术后并发症发生率低于切开修复组（P<0.05）；术后6月、12 月和24月，全关节镜下修复组的 Lysholm 评分、IKDC 评分均高于切开修复组（P<0.05），Tegner 评分在术后12月和24月时，全关节镜下修复组高于切开修复组（P<0.05）。术后随访两组的稳定性无明显统计学差异。结论前交叉韧带自体肌腱重建联合全关节镜下修复内侧副韧带损伤，相较于传统切开修复，具有创伤小、恢复快、并发症少的优势，能更好地恢复膝关节功能，并有可靠的稳定性。

Abstract

Objective To compare the clinical efficacy of autologous reconstruction of the anterior cruciate ligament combined with arthroscopic repair of the medial collateral ligament injury with that of traditional open repair. Methods A total of 64 patients with anterior cruciate ligament injury complicated by medial collateral ligament injury who were treated in our hospital from January 2018 to January 2023 were selected. They were divided into two groups: the group undergoing autologous reconstruction of the anterior cruciate ligament combined with arthroscopic repair of the medial collateral ligament and the open repair group, with 32 cases in each group. The incidence of postoperative complications, as well as the knee joint function scores (Lysholm score, Tegner score, IKDC score) and knee joint stability at 6 months, 12 months, and 24 months after surgery were compared between the two groups. Results The incidence of postoperative complications in the arthroscopic repair group was lower than that in the open repair group (P<0.05). At 6 months, 12 months, and 24 months after surgery, the Lysholm scores and IKDC scores in the arthroscopic repair group were higher than those in the open repair group (P<0.05). The Tegner scores in the arthroscopic repair group were higher than those in the open repair group at 12 months and 24 months after surgery (P<0.05). There was no significant statistical difference in the stability between the two groups during the postoperative follow-up. Conclusions Compared with traditional open repair, autologous reconstruction of the anterior cruciate ligament combined with arthroscopic repair of the medial collateral ligament injury has the advantages of less trauma, faster recovery, and fewer complications. It can better restore the knee joint function and has reliable stability.

导出引用

吴李闯, 叶奕亨, 刘彩龙. 前交叉韧带自体肌腱重建联合全关节镜下修复内侧副韧带损伤与传统切开修复的临床疗效对比[J]. 中国临床解剖学杂志. 2025, 43(6): 703-709 https://doi.org/10.13418/j.issn.1001-165x.2025.6.13

Wu Lichuang, Ye Yiheng, Liu Cailong. Comparison of clinical efficacy between autologous anterior cruciate ligament reconstruction combined with arthroscopic repair of medial collateral ligament injury and traditional open repair[J]. Chinese Journal of Clinical Anatomy. 2025, 43(6): 703-709 https://doi.org/10.13418/j.issn.1001-165x.2025.6.13

中图分类号： R658.3

参考文献

[1] Hassebrock JD, Gulbrandsen MT, Asprey WL, et al. Knee ligament anatomy and biomechanics[J]. Sports Med Arthrosc Rev, 2020,28(3):80-86. DOI:10.1097/JSA.0000000000000279.
[2] 姜文斌, 于胜波, 隋鸿锦. 前交叉韧带损伤的研究进展[J]. 中国临床解剖学杂志,2022,40(3):369-371,375. DOI:10.13418/j.issn.1001-165x.2022.3.23.
Jiang WB, Yu SB, Sui HJ. Research progress of anterior cruciate ligament injury[J]. Chin J Clin Anat, 2022, 40(3): 369-371, 375. DOI:10.13418/j.issn.1001-165x.2022.3.23.
[3] Shultz CL, Poehlein E, Morriss NJ, et al. Nonoperative management, repair, or reconstruction of the medial collateral ligament in combined anterior cruciate and medial collateral ligament injuries-which Is best?A systematic review and meta-analysis[J]. Am J Sports Med, 2024,52(2):522-534. DOI:10.1177/03635465231153157.
[4] Wall C, Byrnes J, Botha L, et al. Acute sport-related knee injuries[J]. Aust J Gen Pract, 2023,52(11):761-766. DOI:10.31128/AJGP-04-23-6785.
[5] Kelly SR, Daniel AV, Smith PA. Open medial meniscotibial ligament repair with concomitant open superficial medial collateral ligament repair with internal brace augmentation[J]. Arthrosc Tech, 2023,13(1):102837. DOI:10.1016/j.eats.2023.09.013.
[6] Ge X, Wang B, Cao F, et al. Arthroscopically assisted repair of the medial collateral ligament of the knee: A case report, description of a new technique[J]. The Knee, 2021,33: 374-377. DOI:10.1016/j.knee. 2021.10.008.
[7] Jacob G, A N S, Kumar G, et al. Percutaneous arthroscopic assisted knee medial collateral ligament repair[J]. Arthrosc Tech, 2020,9(10):e1511-e1517. DOI:10.1016/j.eats.2020.06.014.
[8] Willinger L, Balendra G, Pai V, et al. High incidence of superficial and deep medial collateral ligament injuries in 'isolated' anterior cruciate ligament ruptures: a long overlooked injury[J]. Knee Surg Sports Traumatol Arthrosc, 2022,30(1):167-175. DOI:10.1007/s00167-021-06514-x.
[9] 尹帅, 刘媛媛, 庞胤, 等. 关节镜下自体四股胭绳肌腱前交叉韧带重建术后疗效及影响因素[J]. 中国临床解剖学杂志, 2022, 40(5):592-598. DOI:10.13418/j.issn.1001-165x.2022.5.16.
Yin S, Liu YY , Pang Y , et al. Postoperative effect and influencing factors of the reconstruction of the anterior cruciate ligament with four hamstring tendon autograft under arthroscopy[J]. Chin J Clin Anat, 2022, 40(5): 592-598. DOI:10.13418/j.issn.1001-165x.2022.5.16.
[10]Holuba K, Vermeijden HD, Yang XA, et al. Treating combined anterior cruciate ligament and medial collateral ligament injuries operatively in the acute setting Is potentially advantageous[J]. Arthroscopy, 2023,39(4):1099-1107. DOI:10.1016/j.arthro.2022.06.023.
[11]Wright ML, Coladonato C, Ciccotti MG, et al. Combined anterior cruciate ligament and medial collateral ligament reconstruction shows high rates of return to activity and low rates of recurrent valgus instability: An updated systematic review[J]. Arthrosc Sports Med Rehabil, 2023, 5(3): e867-e879. DOI:10.1016/j.asmr.2023.03.006.
[12]Blaber OK, DeFoor MT, Aman ZA, et al. Lack of consensus on the management of medial collateral ligament tears in the setting of concomitant anterior cruciate ligament injury: A critical analysis[J]. JBJS Rev, 2024,12(6):e24.00036. DOI:10.2106/JBJS.RVW.24. 00036.
[13]Rao R, Bhattacharyya R, Andrews B, et al. The management of combined ACL and MCL injuries: A systematic review[J]. J Orthop, 2022, 34:21-30. DOI: 10.1016/j.jor.2022.07.024.
[14] 姜亚琼, 路坦, 徐彪, 等. 内侧副韧带不同程度损伤时膝关节的应力变化[J]. 中国组织工程研究, 2024, 33(33): 5270-5275. DOI:10.12307/2024.660.
Jiang YQ, Lu T, Xu B, et al. Stress changes of knee joint with different degrees of medial collateral ligament injury[J]. Chinese Journal of Tissue Engineering Research, 2024, 33(33): 5270-5275. DOI:10.12307/2024.660.
[15] 欧霞, 王静宇, 吕云云, 等. 膝关节内侧副韧带损伤的研究进展[J]. 现代医药卫生, 2024, 40(13):2277-2281. DOI: 10.3969/j.issn.1009-5519.2024.13.024.
Ou X, Wang JY, Lv YY, et al. Research progress of medial collateral ligament injury of knee joint[J]. Journal of Modern Medicine & Health, 2024, 40(13): 2277-2281. DOI: 10.3969/j.issn.1009-5519.2024.13.024.
[16]Holuba K, Rilk S, Vermeijden HD, et al. Acute percutaneous repair of medial collateral ligament with suture augmentation in the multiligamentous injured knee results in good stability and low rates of postoperative stiffness[J]. Arthrosc Sports Med Rehabil, 2023,5(6):100799. DOI: 10.1016/j.asmr.2023.100799.
[17] 王长青, 杨荣丽, 付升旗. 前交叉韧带损伤重建术后及随访的弥散张量成像观测[J]. 中国临床解剖学杂志, 2021, 39(5):552-556. DOI: 10.13418/j.issn.1001-165x.2021.05.010.
Wang CQ, Yang RL, Fu SQ. Diffusion tensor imaging observation in the postoperative and follow-up of anterior cruciate ligament reconstruction[J]. Chin J Clin Anat, 2021, 39(5):552-556. DOI: 10.13418/j.issn.1001-165x.2021.05.010.
[18]Billières J, Hopper GP, Carrozzo A, et al. Arthroscopic medial compartment drive-through sign for knee medial collateral ligament complex injuries[J]. Arthrosc Tech, 2022, 11(5):e763-e766. DOI: 10.1016/j.eats.2021.12.034.
[19]Nakashima H, Takahara Y, Uchida Y, et al. Arthroscopic primary medial collateral ligament repair with suture anchor[J]. Arthrosc Tech, 2021,10(2):e269-e274. DOI: 10.1016/j.eats.2020.10.001.
[20] Vosoughi F, Rezaei Dogahe R, Nuri A, et al. Medial collateral ligament injury of the knee: A review on current concept and management[J]. Arch Bone Jt Surg, 2021, 9(3):255-262. DOI:10.22038/abjs. 2021. 48458.2401.
[21] Mowers C, Jackson GR, Condon JJ, et al. Medial collateral ligament reconstruction and repair show similar improvement in outcome scores, but repair shows higher rates of knee stiffness and failure: A systematic review[J]. Arthroscopy, 2023,39(10):2231-2240. DOI: 10.1016/j.arthro.2023.03.002
[22] Malik SS, Osan JK, Aujla R, et al. A systematic review on management and outcome of irreducible knee dislocations[J]. Orthop Traumatol Surg Res, 2022, 108(8): 103415. DOI: 10.1016/j.otsr.2022.103415.