Shelbourne K Donald, Carr Donald R
Methodist Sports Medicine Center, Indianapolis, Indiana, USA.
Am J Sports Med. 2003 Sep-Oct;31(5):718-23. doi: 10.1177/03635465030310051401.
Repair of meniscal tears is generally preferred over meniscectomy.
Repair of unstable bucket-handle tears of the medial meniscus leads to better outcomes than partial meniscectomy.
Retrospective review of prospectively collected data.
We reviewed the records of 155 patients who had isolated bucket-handle medial meniscal tears and anterior cruciate ligament tears. Fifty-six menisci were repaired; 99 that were degenerative and crushed beyond repair were removed. Patients were evaluated at a mean follow-up of 6 to 8 years after surgery with the International Knee Documentation Committee examination and a modified Noyes questionnaire.
The mean subjective scores were similar for patients in both the repair (N = 51) and meniscectomy (N = 87) groups. However, in the repair group, the mean subjective score of 93.9 for nondegenerative menisci was significantly better than the 87.1 for degenerative menisci. Objective grades for 25 patients in the repair group were normal or nearly normal in 22 patients (88%) and for 51 of 56 patients (91%) in the removal group. Radiographic subscores for the repair group were normal or nearly normal in 23 patients in the repair group and 49 in the removal group.
Outcomes from meniscal repair were not superior to those from partial removal. Patients with repaired degenerative tears had significantly lower subjective scores than those with nondegenerative tears.
半月板撕裂的修复通常比半月板切除术更受青睐。
内侧半月板不稳定桶柄状撕裂的修复比部分半月板切除术能带来更好的结果。
对前瞻性收集的数据进行回顾性分析。
我们回顾了155例孤立性内侧半月板桶柄状撕裂合并前交叉韧带撕裂患者的记录。56个半月板进行了修复；99个因退变和挤压严重无法修复而被切除。术后平均随访6至8年时，采用国际膝关节文献委员会检查和改良的诺伊斯问卷对患者进行评估。
修复组（N = 51）和半月板切除组（N = 87）患者的主观评分均值相似。然而，在修复组中，非退变半月板的主观评分均值93.9显著高于退变半月板的87.1。修复组25例患者的客观分级中，22例（88%）正常或接近正常，切除组56例中的51例（91%）正常或接近正常。修复组的影像学分项评分中，23例正常或接近正常，切除组49例正常或接近正常。
半月板修复的结果并不优于部分切除。修复退变撕裂的患者主观评分显著低于非退变撕裂的患者。
