内侧副韧带解剖治疗方案的选择ppt医学课件.pptx

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,2018/9/3 Monday,#,Anatomy,Anatomy,Anatomy,MCL Inury,the MCL is injured in at least 42%of knees with ligamentous injuries,0.24 per 1,000 people in USA,O,Donoghue,s unhappy triad,：,MCL,anterior cruciate ligament,and medial meniscus tears,Wijdicks et al.showed that the distal tibial,attachment of the sMCL was the strongest,followed by the,POL and dMCL.The proximal tibial attachment of the,sMCL was the weakest 9.Wilson et al.reported that in,their experiments,the sMCL typically failed at the femoralattachment site 10,MCL Inury,Valgus stress test and Dial test,Grade 1 superficial MCL injury,Grade 2 superficial MCL injury,Grade 2 superficial MCL injury,Grade 2,3 MCL distal tear and,Grade 3 MCL tear,Grade 3 MCL tear,Deep MCL tear,Subacute and chronic MCL injurie,avulsion fracture of the medialfemoral epicondyle,Pellegrini,Stieda lesion,MCL bursitis,The MCL bursa,also known as Voshell,s bursa,is present in 91%of knees,Treatment,Grade 1,Grade 2,The robust intrinsic healing capability of the MCL is well documented,largely owing to its extracapsular location,Grade 3,：,Surgery?,treated conservatively,Conservative Treatment,The conservative care of the isolated MCL injury should be protection against valgus stress using a brace that allows motion of the knee,but protects against a valgus stress.Prolonged immobilization,such as a long leg cast,has been shown to have a deleterious effect on the healing of the medial ligament,Treatment of isolated clinical grade III tears,Initial nonoperative management is also usually preferred even for isolated clinical grade III tears in patients with an intact anterior cruciate ligament,Hinged knee brace for six weeks to protect against valgus stress and external rotation,Some surgeons prefer to address bony avulsions with operative management when present,When a bony avulsion is present,a cancellous screw may be used for fixation of the bony fragment,Treatment of combined superficial MCL and POL tear,Postoperative Rehabilitation,It is important to inform patients prior to the operation that their full return to activity can take up to six to nine month postoperatively,Avoid aggressive range-of-motion exercises in the first week,ROM:0-90 in the first 2 weeks while wearing a hinged brace,No resistive or repetitive hamstring exercises be performed for approximately four months after the reconstruction,full weight-bearing is permitted at the seventh week,MCL combined ACL injury,Early repair has been shown in animal models to create a positive healing environment for the MCL,as stability and reapproximation of the ligament is achieved.However,recent reviews of the literature still address controversy regarding early versus late operative treatment,and there are a lack of appropriate studies to make a final determination.,Take home message,Grade 1 and 2 MCL injury treatment:hinged knee brace for 3-6 weeks,Isolated Grade 3 MCL tear:Initial nonoperative management for 6 weeks,MCL tear with bony avulsions:Operation,MCL combined POL rupture:Repair/Reconstruction,MCL combined ACL/PCL rupture:controversy,