| Objective: The anterior cruciate ligament (ACL) and medical collateralligament (MCL) injury is common in clinical. Presently, after ACL injury onthe need for surgical reconstruction to restore the stability of the knee has beena common understanding. The MCL I°injury is often treated conservativelywith satisfactory results, and the MCL III°injury require surgery. Whether theMCL II°injury needs surgery or not, scholars still have controversial attitude.Some scholars believe that the MCL has a strong ability to heal itself, byconservative treatment can achieve satisfactory clinical results. Other scholarsthink that it is easy to identify the anatomical structures after the acute phaseof MCL injury, and can be repaired to avoid chronic knee instability. But aboutthe treatment of ACL and MCL injury, t here is no unified program. In thisstudy,54patients were divided into two groups, the MCL conservativetreatment group and the MCL surgery treatment group, by clinical follow-upKT1000,ROM and IKDC score, analysis the effect of ACL and MCL injury onthe stability of the knee, and provide reference for clinical.Methods: We take54patients who had acute ACL and MCL II°injuryin the third hospital of Hebei Medical University from January of2011toMarch of2012. They are from27to40years old, and their average age is34years. All patients had a clear history of trauma, duration<1week, of which19cases of traffic accidents,7cases of pounded and28cases of sports injuries.All patients took X-ray and MRI when they were hospitalized. Preoperativeinspection shows anterior drawer test positive, after drawer test negative,0°valgus stress test negative,30°valgus stress test positive, local tenderness ofthe MCL femoral insertion,30°of knee stress X-ray shows medial gapwidened3~5mm. Preoperative MRI examination showed complete disappearance or discontinuity of ACL, high signal of MCL femoral insertion.The results of examination after anesthesia was the same as hospitalized. Allpatients were divided into A, B groups randomly. There are26patients (10female,16male), amounting to26knees, who take the ACL reconstructionand MCL repair in Team A. Their average age is34years, and there are17leftknees and9right knees. Their body weight is66.90±9.37kg, preoperativerange of motion is109.59±10.09, IKDC score is58.92±6.56. There are28patients (7female,21male), amounting to28knees, who take the ACLreconstruction and MCL repair in Team B. Their average age is35years, andthere are12left knees and16right knees. Their body weight is68.07±6.45kg,preoperative range of motion is101.06±11.27, IKDC score is60.68±6.63.There are no statistics differences at the average ages，body weight and IKDCsocre of those patients in two Teams. All patients were taken the KT-1000knee arthrometer at30°of the knee, record the maximum forwarddisplacement, the range of motion and the international knee documentationcommittee knee uation form. And the author analysis the difference onmaximum forward displacement of knee, ROM and IKDC score by SPSS20.0softwareResults:1All patients’s incision were healed. The postoperativeexamnination showed that the drawer test, lachman test and valgus stress testwere all negative in team A. The drawer test, lachman test were negative inteam B. Postoperative deep venous ultrasound showed3patients hadthrombosis between muscle meridians. All patients were followed-up, theaverage is12~14months. No patient experienced joint adhesions, vascularand nerve injury.2MCL inspection after surgery: When the review after12months, thestress test were negative in all patients by side extension position. During30°of knee flexion, there are2patients have positive results in team A, stressX-ray show the medial joint space widened were5mm,7mm. There are9patients have positive results in team B, stress X-ray show the medial jointspace widened were4~9mm. 3KT-1000test: When the review after12months, the maximum forwarddisplacement of the knee in team A is （3.4±1.2）mm, the maximum forwarddisplacement of the knee in team B is （5.2±1.8）mm. The maximumdisplacement in team A is less than that in team B, There were significantdifferences between the two groups(P <0.05)4ROM test: When the review after12months, the ROM of team A was130.4±2.25°, and in team B, it was123.6±2.4°, there is no statisticalsignificance on the difference of the knee range of motion (P>0.05).5IKDC score: The IKDC score in team A was86.5±5.5, and in team B, itwas69.2±3.7, there was statistical significance between the two team (P<0.05).In team B, there were65.38%of patients (17knees) returned to normalor near normal knee function,34.62%(9knees) still abnormal. In team A,there were92.58%(26knees) returned to normal or near normal knee function,7.1%(2knees) still abnormal.Conclusion: In the valgus stability, postoperative IKDC score and axialstability of knee, ACL reconstruction and MCL repair is better then ACLreconstruction and MCL conservative treatment. In the ROM after operation,there is no statistical significance between the two team. |
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