Belzer JP, Cannon WD
Department of Orthopaedic Surgery, University of California at San Francisco.
J Am Acad Orthop Surg. 1993 Oct;1(1):41-47. doi: 10.5435/00124635-199309000-00006.
Basic science research and follow-up studies after meniscectomy have provided convincing evidence of the importance of preservation of the meniscus in decreasing the risk of late degenerative changes. Whether in a stable or an unstable knee, if a meniscus tear cannot be repaired, a conservative partial meniscectomy should be undertaken to preserve as much meniscal tissue as possible. When feasible, repair should be carried out in young patients with an isolated meniscus tear, despite healing rates that are significantly lower than those obtained when meniscus repair is done with anterior cruciate ligament (ACL) reconstruction. The incidence of successful healing is inversely related to the rim width and tear length. In general, meniscus repair should be limited to patients under 50 years of age. Vertical longitudinal tears, including bucket-handle tears, are most amenable to repair. Some radial split tears can be repaired. In an ACL-deficient knee, meniscus repair is more prone to failure if not performed in conjunction with an ACL reconstruction, and is not recommended. Meniscal allograft surgery is investigational but may hold promise for selected patients.
半月板切除术后的基础科学研究及随访研究已提供了令人信服的证据，证明保留半月板对于降低晚期退变风险的重要性。无论膝关节是稳定还是不稳定，如果半月板撕裂无法修复，则应进行保守性部分半月板切除术，以尽可能多地保留半月板组织。在可行的情况下，对于单纯半月板撕裂的年轻患者应进行修复，尽管其愈合率明显低于半月板修复与前交叉韧带（ACL）重建同时进行时的愈合率。成功愈合的发生率与边缘宽度和撕裂长度呈负相关。一般来说，半月板修复应限于50岁以下的患者。垂直纵向撕裂，包括桶柄状撕裂，最适合修复。一些放射状撕裂也可修复。在ACL缺失的膝关节中，如果不与ACL重建同时进行，半月板修复更容易失败，因此不建议这样做。半月板同种异体移植手术仍处于研究阶段，但可能对特定患者有前景。
