Autogenous tendon transplantation for repair of grade III medial collateral ligament injury

doi:10.3969/j.issn.2095-4344.2014.46.017

Abstract

Abstract:

BACKGROUND: Young patients with cruciate ligament injury and high activity levels are prone to grade III medial collateral ligament injury in knee joint. Conventional construction methods such as direct restoration of injured ligaments and muscle-tendon transposition may induce the loosening of medial collateral ligament complex.

OBJECTIVE: To explore the clinical effect of autologous tendon transplantation for grade III medial collateral ligament injury of the knee joint.

METHODS: Forty-seven patients with grade III medial collateral ligament rupture were treated by operative repair and reconstruction. After repairing the anatomical structure of medial collateral ligaments, we liberated organic semitendinous tendon, bone-patella tendon-bone, and hamstring tendon, to reconstruct superficial medial collateral ligament.

RESULTS AND CONCLUSION: Thirty-seven patients were followed up for 48 months. Preoperative Lysholm score, IKDC score, Tegner score at the final follow-up, and the widened medial joint space on valgus stress X-Ray films were significantly improved compared with before reconstruction (P < 0.05). According to clinical efficacy scores, 12 cases achieved excellent reconstruction, 18 cases achieved good reconstruction, 4 cases achieved moderate reconstruction, and 3 cases achieved poor reconstruction. The excellent and good rate was 82%. Medial collateral ligament reconstruction based on repairing the anatomical structure is effective and satisfactory. Autologous bone-patella tendon-bone or semitendinous tendon is a good choice for medial collateral ligament reconstruction.

中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程

全文链接：

Key words: tissue engineering, knee joint, ligament, transplantation

CLC Number:

R318

Zhu Wei-hong, Chen You, Wang Wan-chun, Huang Guo-liang, Chou Ke, Chen Xian-li. Autogenous tendon transplantation for repair of grade III medial collateral ligament injury [J]. Chinese Journal of Tissue Engineering Research, 2014, 18(46): 7463-7467.

Figures/Tables 2

2.1 受试者数量分析纳入患者47例，按排除标准排除10例，最终37例患者进入结果分析。 2.2 受试者基线资料按以上标准共排除10例患者，其中4例合并有血管或神经血管损伤、4例合并有开放性骨折脱位、2例合并有其他严重复合伤。最终纳入37例患者，男22例，女15例，平均年龄30.2(16-58)岁；左膝病变者13例，右膝病变者24例，病程4 h-2年，全部病例均有明确外伤史。纳入的37例病例患膝均有内侧疼痛及不稳。急性期病例以疼痛为主，伴关节肿胀、活动障碍；慢性期病例以内侧或前内侧不稳、乏力、跛行为主。主要体征为内侧副韧带行程区中某点压痛，急性病例伴有局部肿胀，所有病例膝关节30°位外翻应力试验阳性；30°及0°位均阳性者25例，其中慢性不稳者12例。X射线双膝外翻应力位检查，内侧间隙增宽与正常比较大于3 mm者27例，大于5 mm者10例，见图1A。关节镜探查多合并有半月板损伤、软骨损伤或交叉韧带损伤；部分还合并有后关节囊损伤。37例中内侧副韧带重建采用2股或3股半腱肌腱移植物重建者12例，采用骨-髌韧带-骨移植物重建者18例，深层股骨止点撕脱骨折复位螺钉固定+半腱肌腱重建3例，原位修复+半腱肌腱或股薄肌腱加强4例。10例后关节囊损伤患者在行游离腱移植重建内侧副韧带的基础上转移股薄肌腱或半腱肌腱加强后内侧关节囊。 2.3 自体肌腱移植修复膝关节内侧副韧带Ⅲ度损伤的效果 37例患者全部获随访，但有8例患者仅于重建后半年至1年内取出内固定而再次手术时获随访。随访时间48(24-114)个月。37例患者Lysholm评分、IKDC评分、Tegner最终随访评分、外翻应力位X射线片内侧关节间隙较健侧增宽的距离均较重建前明显改善，差异均有显著性意义(P < 0.05)，见表1。 37例患者重建后按临床疗效评分为优12例，良18例，中4例，差3例，优良率81%。评分为中和差者主要表现为关节疼痛及关节屈曲功能障碍，仅1例仍有内侧明显不稳定症状，外翻应力位X射线照片检查，患膝内侧间隙增宽> 5 mm，其他患者患膝内侧间隙增宽< 2 mm，见图1B。膝关节屈伸功能未完全恢复者4例，其中2例活动范围为0°-120°，1例为5°-120°，1例为10°-120°，在麻醉下行手法复位和关节镜下粘连松解后关节活动度恢复正常。"

References

[1] Fetto JF, Marshall JL. Medial collateral ligament injuries of the knee: a rational for treatment. Clin Orthop. 1978;(132):206-218.
[2] Phisitkul P, James SL, Wolf BR, et al. MCL injuries ofthe knee: current concepts review. Iowa Orthop J. 2006;26:77-90.
[3] Baker CL, Shalvoy RM. Treatment of acute and chronic injuries to the medial structures of the knee. Op Tech Sports Med. 1996;4:166-173.
[4] Marx RG. Operative and nonoperative treatments of medial collateral ligament rupture were not different in combined medial collateral and anterior cruciate ligament rupture. J Bone Joint Surg Am. 2007;89(2):457.
[5] Richmond JC. Complications associated with the treatment of multiligament-injured /dislocated knee. Sports Med Arthrose Rev. 2001;9:255-260.
[6] Robinson JR, Sanchez-Ballester J, Bull AM, et al. The posteromedial corner revisited-an anatomical description of the passive restraining structures of the medial aspect of the human knee. J Bone Joint Surg. 2004;86(5):674-681.
[7] Kim SJ, Lee DH, Kim TE, et al. Concomitant reconstruction of the medial collateral and posterior oblique ligaments for medial instability of the knee. J Bone Joint Surg Br. 2008; 90(10) :1323-1327.
[8] Ikuma H, Abe N, Uchida Y, et al. Novel magnetic resonance imaging evaluation for valgus instability of the knee caused by medial collateral ligament injury. Acta Med Okayama. 2008; 62(3):185-191.
[9] Warren RF, Marshall JL. Injuries of the anterior cruciate ligament and medial collateral ligaments of the knee: a long term follow-up of 86 cases. Part II. Clin Orthop. 1978;136(10): 198-211.
[10] Leo CC, Vernon JC, Thomas DR. Medial collateral ligament healing response technique: microperforation. Tech Knee Surg. 2002;1(1):36-42.
[11] Indelicato PA. Nonoperative management of complete tears of the medial collateral ligament of the knee in intercollegiate football players. J Bone Join Surg. 1983;65A:323-329.
[12] Halinen J, Lindahl J, Hirvensalo E, et al. Operative and non- operative treatments of medial collateral ligament rupture with early anterior cruciate ligament reconstruction: a prospective randomized study. Am J Sports Med. 2006;34(7):1134-1140.
[13] Kanamori A, Sakane M, Zeminski J, et al. In-situ force in the medial and lateral structures of intact and ACL-deficien knees. J Orthop Sci. 2000;5(6):567-571.
[14] SakaneM, Livesay GA, Fox RJ, et al. Relative contribution of the ACL, MCL, and bony contact to the anterior stability of the knee. Knee Surg Sports Traumatol Arthrosc. 1999;7(2):93-97.
[15] Abramowitch SD, Yagi M, Tsuda E, et al. The healing medial collateral ligament following a combined anterior cruciate and medial collateral ligament injury-a biomechanica study in a goat model. J Orthop Res. 2003;21(6):1124-1130.
[16] Ohno K, Pomaybo AS, Schmidt CC, et al. Healing of the medial collateral ligament after a combined medial collateral and anterior cruciate ligament injury and reconstruction of the anterior cruciate ligament: comparison of repair and nonrepair of medial collateral ligament tears in rabbits. J Orthop Res. 1995;13(3):442-449.
[17] Daniel DM, Malcom L, Stone ML. Quantification of knee function. Orthop Trans 1981;5:489-490.
[18] Ballmer PM, Ballmer FT, Jakob RP. Reconstruction of the anterior cruciate ligament alone in the treatment of a combined instability with complete rupture of the medial collateral ligament. A prospective study. Arch Orthop Traum Surg. 1991;110(3):139-141.
[19] Keith LT, Dean CT. Medial collateral ligament injuries of the knee: an evolution of surgical reconstruction. Tech Knee Surg. 2002;1(2):137-145.