Frosch K H, Fuchs M, Losch A, Stürmer K M
Department of Trauma Surgery, Plastic and Reconstructive Surgery, Georg August University Goettingen, Robert Koch Str. 40, 37075 Goettingen, Germany.
Arch Orthop Trauma Surg. 2005 Nov;125(9):585-91. doi: 10.1007/s00402-004-0775-1.
Total meniscus resection usually leads to osteoarthritis of the knee joint. Preservation and refixation of the injured menisci are therefore of great clinical importance.
The present study examines 40 meniscal injuries in 37 patients that were arthroscopically treated with Clearfix meniscal screws (Mitek, Norderstedt, Germany) in the period from August 1999 to December 2002. The mean patient age was 27.7 (range 16-62) years. Nine patients were female. A total of 24 patients (27 meniscal tears) also had an anterior cruciate ligament (ACL) lesion, and 5 patients had cartilage injuries. Twenty-two patients were treated within the first 2 weeks following the trauma, 10 patients within 8 weeks, and 5 patients after 8 weeks. The lesions were a bucket-handle tear of the medial meniscus in 11 cases and a bucket-handle tear of the lateral meniscus in 2 cases. The posterior horn of the medial meniscus was torn in 13 cases, and the pars intermedia in 3 cases. The posterior horn of the lateral meniscus was torn in 8 cases, and the pars intermedia in 3 cases. The mean tear length was 2.9 (+/- 1.5) cm and was fixed with an average of 1.8 (+/- 0.7) screws. In 7 cases, the anterior horn was treated with an additional meniscal suture. A total of 35 patients were examined after an average of 18 (range 7-45) months.
In the event of a moderate outcome, MRI was performed as part of the follow-up investigation. The average Lysholm score was 93 (+/- 7.4), the Tegner activity index was 6.3 (+/- 2.0) before the accident and 5.8 (+/- 2.0) at the follow-up, the Marshall knee score was 47 (+/- 3.8). The VAS pain assessment was 1.6 (+/- 1.3) and the VAS function assessment was 7.9 (+/- 1.6). Of the 7 patients with a moderate result, 2 patients without additional ligament lesions suffered re-ruptures after and 13 months, respectively. The other 5 patients with a moderate result each had multiple accompanying injuries or pre-existing damage to the affected knee joint.
The Clearfix screws achieved a clinical success rate of 82% in isolated meniscal tears in stable knee joints and a clinical success rate of 100% with additional ACL reconstruction. In view of the good clinical results and the simple procedure for use, the implant should be recommended for meniscal refixation.
半月板全切除通常会导致膝关节骨关节炎。因此，损伤半月板的保留和重新固定具有重要的临床意义。
本研究对1999年8月至2002年12月期间37例患者的40例半月板损伤进行了关节镜检查，采用德国诺德施泰特的Mitek公司生产的Clearfix半月板螺钉进行治疗。患者平均年龄为27.7岁（范围16 - 62岁）。9例为女性。共有24例患者（27处半月板撕裂）同时伴有前交叉韧带（ACL）损伤，5例患者有软骨损伤。22例患者在创伤后2周内接受治疗，10例患者在8周内接受治疗，5例患者在8周后接受治疗。损伤类型为内侧半月板桶柄状撕裂11例，外侧半月板桶柄状撕裂2例。内侧半月板后角撕裂13例，中间部分撕裂3例。外侧半月板后角撕裂8例，中间部分撕裂3例。平均撕裂长度为2.9（±1.5）cm，平均使用1.8（±0.7）枚螺钉进行固定。7例患者的前角采用额外的半月板缝合治疗。平均18个月（范围7 - 45个月）后，共对35例患者进行了检查。
对于结果为中等的患者，作为随访调查的一部分进行了MRI检查。平均Lysholm评分为93（±7.4），Tegner活动指数在事故前为6.3（±2.0），随访时为5.8（±2.0），Marshall膝关节评分为47（±3.8）。视觉模拟评分法（VAS）疼痛评分为1.6（±1.3），VAS功能评分为7.9（±1.6）。在7例结果为中等的患者中，2例无其他韧带损伤的患者分别在6个月和13个月后发生再次撕裂。其他5例结果为中等的患者均有多处合并伤或患膝关节存在既往损伤。
Clearfix螺钉在稳定膝关节单纯半月板撕裂中的临床成功率为82%，在联合ACL重建时临床成功率为100%。鉴于良好的临床效果和简单的使用方法，该植入物应推荐用于半月板重新固定。
