Lee Dae-Hee, Kim Tae-Ho, Kim Jong-Min, Bin Seong-Il
Department of Orthopaedic Surgery, Korea University School of Medicine, Anam Hospital, Seoul, South Korea.
Arthroscopy. 2009 May;25(5):496-503. doi: 10.1016/j.arthro.2008.10.025.
The purpose of this study was to compare the midterm outcomes of subtotal/total meniscectomy with those of partial meniscectomy for symptomatic torn discoid lateral meniscus (DLM) in children and evaluate the correlation of chondral wear in the lateral compartment at index surgery with arthritic changes at final follow-up.
We reviewed 43 knees in 36 patients aged less than 15 years who underwent arthroscopic procedures for torn DLMs between 1999 and 2004. The mean patient age at the time of surgery was 9.5 years (range, 5 to 14 years), and the mean follow-up period was 4.3 years (range, 2.1 to 9.4 years). Of the 43 knees, 23 underwent partial meniscectomy and 20 underwent subtotal/total meniscectomy. The status of the articular cartilage at the time of surgery was analyzed with the Outerbridge grading system, and radiologic arthritic changes of the lateral compartment at final follow-up were evaluated by use of the classification of Tapper and Hoover.
Clinically excellent or good results at final follow-up were observed in 36 of 43 knees (83.7%). There was no difference between the partial and subtotal/total meniscectomy groups in terms of the presence of chondromalacia of the lateral compartment at the time of surgery. Radiologic arthritic changes at final follow-up were significantly more severe in the subtotal/total meniscectomy group than in the partial meniscectomy group (P < .001). We observed a positive linear association between the degree of chondral wear of the lateral tibial plateau at the time of surgery and subsequent development of radiologic signs of arthritic change at last follow-up (rho = .628, P = .027). We also found a correlation between symptom duration and chondromalacia of the lateral tibial plateau (rho = .684, P = .021).
Although there were no differences in clinical results between the partial and subtotal/total meniscectomy groups, partial meniscectomy yielded better radiologic results than subtotal/total meniscectomy for torn DLMs in children. Our findings suggest the need for early diagnosis and greater caution in the treatment of torn DLMs in children.
Level IV, therapeutic case series.
本研究旨在比较儿童有症状的盘状外侧半月板（DLM）撕裂行次全/全半月板切除术与部分半月板切除术的中期疗效，并评估初次手术时外侧间室软骨磨损与末次随访时关节炎改变的相关性。
我们回顾了1999年至2004年间36例年龄小于15岁因DLM撕裂接受关节镜手术的患者的43个膝关节。手术时患者的平均年龄为9.5岁（范围5至14岁），平均随访期为4.3年（范围2.1至9.4年）。43个膝关节中，23例行部分半月板切除术，20例行次全/全半月板切除术。手术时用Outerbridge分级系统分析关节软骨状态，末次随访时用Tapper和Hoover分类法评估外侧间室的放射学关节炎改变。
43个膝关节中36个（83.7%）在末次随访时临床结果为优或良。部分半月板切除术组与次全/全半月板切除术组在手术时外侧间室软骨软化的存在方面无差异。末次随访时次全/全半月板切除术组的放射学关节炎改变明显比部分半月板切除术组严重（P <.001）。我们观察到手术时外侧胫骨平台软骨磨损程度与末次随访时关节炎改变放射学征象的后续发展呈正线性相关（rho = 0.628，P = 0.027）。我们还发现症状持续时间与外侧胫骨平台软骨软化之间存在相关性（rho = 0.684，P = 0.021）。
虽然部分半月板切除术组与次全/全半月板切除术组的临床结果无差异，但对于儿童DLM撕裂，部分半月板切除术的放射学结果优于次全/全半月板切除术。我们的研究结果表明，对于儿童DLM撕裂需要早期诊断并在治疗时更加谨慎。
IV级，治疗性病例系列。
