Jäger A, Braune C, Welsch F, Khoudeir S, Rauschmann M A
Abt. f. Allg. Orthopädie u. Traumatologie d. Orthopädischen Universitätsklinik Frankfurt, Germany.
Zentralbl Chir. 2002 Oct;127(10):890-4. doi: 10.1055/s-2002-35136.
We retrospectively evaluated the clinical outcome of arthroscopic assisted meniscal suture repair in athletes on different competitive sports levels with stable joint function and persisting anterior knee instability. Return to former sports levels and early osteoarthrotic changes were especially focussed. Examination included 50 athletes (32 men, 18 women) who underwent meniscal repair in inside-out technique during the period of 1989 to 1998. 23 patients had isolated full-thickness meniscal tears, 27 an associated rupture of the anterior cruciate ligament which was reconstructed in 13 cases with a patellar-tendon autograft. 3 study groups were formed referring to the athletes preoperative sports level evaluated with Tegner's score. Reexamination included Lysholm score, IKDC score and Fairbank's score. With a mean age of 32.1 years (range 13-53 years) and an average follow-up of 6.3 years 72 % of the patients (n = 36) showed a stable joint function on reexamination. With no persisting anterior knee instability 86 % of the professional athletes returned to former full sports activities on competitive levels. Non competitive athletes returned in all cases (100 %) to their former level. Fairbank's score increased by 0.1 observing minimal osteoarthitic signs. However, persisting anterior knee instability showed on reexamination poor results. Only one third of all athletes were able to return to former activity levels. Osteoarthritic changes were observed in all patients. Professional athletes had the most severe osteoarthritic changes with a significant (p = 0.03) increase of 0.8 in Fairbank's score. The results demonstrate that complete recovery on sports activities after meniscal repair is not possible without reconstruction of the anterior cruciate ligament. Isolated meniscal repair shows poor results in persisting anterior knee instability and does not prevent increasing osteoarthritic changes in athletes.
我们回顾性评估了关节镜辅助下半月板缝合修复术在不同竞技运动水平、关节功能稳定但存在持续性前膝不稳的运动员中的临床疗效。尤其关注恢复至之前运动水平以及早期骨关节炎改变的情况。研究对象包括50名运动员（32名男性，18名女性），他们于1989年至1998年期间接受了由外向内技术的半月板修复术。23例患者为单纯全层半月板撕裂，27例伴有前交叉韧带断裂，其中13例采用髌腱自体移植重建了前交叉韧带。根据用Tegner评分评估的运动员术前运动水平形成了3个研究组。复查包括Lysholm评分、IKDC评分和Fairbank评分。患者平均年龄32.1岁（范围13 - 53岁），平均随访6.3年，72%的患者（n = 36）复查时关节功能稳定。86%的职业运动员在无持续性前膝不稳的情况下恢复到了之前的全项竞技运动水平。非竞技运动员全部（100%）恢复到了之前的水平。Fairbank评分增加了0.1，观察到轻微的骨关节炎体征。然而，复查时持续性前膝不稳的结果较差。所有运动员中只有三分之一能够恢复到之前的活动水平。所有患者均观察到骨关节炎改变。职业运动员的骨关节炎改变最为严重，Fairbank评分显著增加了0.8（p = 0.03）。结果表明，若不重建前交叉韧带，半月板修复术后不可能完全恢复运动活动。单纯半月板修复在持续性前膝不稳的情况下效果不佳，且不能防止运动员骨关节炎改变的加重。
