小结
定义
内侧副韧带 (MCL) 是膝关节内侧的支撑结构。 [Figure caption and citation for the preceding image starts]: 内侧副韧带（右侧膝关节）由医学博士 Sanjeev Bhatia 创建；经许可后使用 [Citation ends].
其首要功能是限制胫骨相对于股骨的外翻（由中线向外扭转）和外旋。内侧副韧带损伤的机制通常是突然施加于膝关节的外翻作用力和/或外旋作用力过大。内侧副韧带损伤的严重程度范围可从少量韧带纤维撕裂至韧带的完全离断。
病史和体格检查
关键诊断因素
- 存在的危险因素
- 由于过度或反复的内侧副韧带外翻负荷导致的损伤
- 膝关节内侧痛
- 关节渗出
- 触痛
- 外翻应力松弛试验
其他诊断因素
- 瘀斑
- 损伤时可听见爆裂声或撕裂感
- 行走困难
- 膝关节不稳定症状
- 膝关节机械症状
- 膝关节变形
- 前抽屉试验阳性
- 后抽屉试验阳性
- Lachman 试验阳性
- 轴移试验阳性
- 关节线压痛
- 慢性疼痛
危险因素
- 参与涉及膝关节外翻应力的活动
- 年龄为 20 至 35 岁
- 年龄为 55 至 70 岁
- 膝关节的内侧肌肉薄弱
诊断性检查
首要检查
- 膝关节 X 线平片
- 膝关节应力位 X 线平片
需考虑的检查
- 膝关节部位 MRI
新兴检查
- 诊断性超声检查
治疗流程
单纯性 I 级损伤
单纯性 II 级损伤
单纯性 III 级损伤
内侧副韧带 + 前交叉韧带 (ACL) 合并损伤
内侧副韧带 + 非前交叉韧带 (ACL) 合并损伤
≥3 个月后高度外翻松弛持续
撰稿人
作者
Sanjeev Bhatia, MD
Co-Director, Hip & Knee Joint Preservation Center
Northwestern Medicine Central DuPage Hospital
Northwestern University Feinberg School of Medicine
Warrenville
IL
利益声明
SB receives royalties from the following Nova publication: Ligamentous Injuries of the Knee. SB has stock ownership in Vericel and Joint Preservation Innovations, LLC.
Nikhil N. Verma, MD
Professor
Department of Orthopedic Surgery
Section of Sports Medicine
Rush University Medical Center
Chicago
IL
利益声明
NNV declares the following competing interests: American Orthopaedic Society for Sports Medicine: board or committee member; American Shoulder and Elbow Surgeons: board or committee member; Arthrex, Inc.: research support; Arthroscopy: publishing royalties, financial or material support; Arthroscopy Association of North America: board or committee member; Breg: research support; Cymedica: stock or stock options; Knee: editorial or governing board; Minivasive: paid consultant, stock or stock options; Omeros: stock or stock options; Orthospace: paid consultant; Ossur: research support; SLACK Incorporated: editorial or governing board; Smith & Nephew: IP royalties, research support; Vindico Medical-Orthopedics Hyperguide: publishing royalties, financial or material support; Wright Medical Technology, Inc.: research support.
同行评议者
Daniel J. Solomon, MD
Co-director of Orthopedic Sports and Shoulder Service
Department of Orthopedic Surgery
Naval Medical Center San Diego
San Diego
CA
利益声明
DJS declares that he has no competing interests.
Robert Werner, MD
Professor
Chief of Physical Medicine and Rehabilitation
Ann Arbor VA Medical Center
Ann Arbor
MI
利益声明
RW has been reimbursed by the University of Michigan for attending several conferences and has been paid an honorarium for speaking at the American Association of Neuromuscular and Electrodiagnostic Medicine national meeting. RW has been paid by the National Institute for Occupational Safety and Health, the American Dental Association, and SmartHealth as a consultant and has received grant funding from the UAW/GM Health and Safety Board (over US$1 million).
Matthew T. Provencher, MD
Assistant Director
Orthopaedic Shoulder and Sports Surgery
Naval Medical Center San Diego
San Diego
CA
利益声明
MTP declares that he has no competing interests.
Philip H. Cohen, MD
Clinical Assistant Professor of Medicine
Robert Wood Johnson Medical School
University of Medicine and Dentistry of New Jersey
Piscataway
NJ
利益声明
PHC declares that he has no competing interests.
Jung-Ro Yoon, MD
Orthopedic Surgeon
Department of Orthopedic Surgery
Seoul Veterans Hospital
Seoul
South Korea
利益声明
JRY declares that she has no competing interests.
鉴别诊断
- 内侧半月板撕裂
- 膝关节内侧软组织挫伤
- 胫骨平台骨折
更多 鉴别诊断指南
- 前交叉韧带损伤的管理：循证指南
更多 指南
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