重度内侧副韧带损伤与慢性膝关节内侧不稳的手术治疗：一项系统评价
简介
该综述纳入35项研究，评估高等级MCL损伤和慢性内侧膝不稳手术，主张按临床表型而非单纯MCL分级决策。急性ACL重建时常规内侧手术在III级损伤中未一致获益；移位性远端或Stener样病变可考虑修复，慢性外翻和/或前内侧旋转不稳多行重建，稳定性和患者报告结局有改善，但证据确定性低。决策需综合可修复性、残余不稳、合并韧带损伤、力线和组织质量。
英文摘要
High-grade medial collateral ligament (MCL) injury and chronic medial knee instability can compromise both valgus and rotational control, especially in cruciate or multiligament injury. This systematic review evaluated operative treatment according to clinical phenotype rather than MCL grade alone. PubMed/MEDLINE and Web of Science Core Collection were searched from January 1, 2000, to August 10, 2026; a Cochrane CENTRAL update was completed on September 7, 2026. Eligible clinical reports included operative treatment of acute high-grade MCL/medial-complex injury or chronic symptomatic medial instability. Risk of bias was assessed with RoB 2, ROBINS-I, or the Joanna Briggs Institute case-series checklist. Thirty-five reports were included: 5 randomized or quasi-randomized trials, 9 nonrandomized comparative studies, and 21 case series. Routine acute medial surgery during ACL reconstruction was not consistently superior across heterogeneous grade III populations. In contrast, selected displaced distal or Stener-like lesions were plausible repair targets because interposition can prevent healing in apposition. Chronic symptomatic valgus and/or anteromedial rotatory insufficiency was most often treated with reconstruction, with directional improvement in objective stability and patient-reported outcomes in case series. Evidence for augmentation, the optimal reconstruction construct, and timing remains low certainty. Decisions should integrate repairability, residual valgus and rotational instability, associated ligament injury, alignment, and tissue quality. Prospective phenotype-stratified comparative studies using standardized stability, return-to-sport, complication, and long-term joint-preservation outcomes are required.Level of evidence: Level IV, systematic review of Level I-IV therapeutic studies.