Orthopaedic department, André-Mignot Hospital, 78150 Le Chesnay, France.
Orthop Traumatol Surg Res. 2009 Oct;95(6):437-42. doi: 10.1016/j.otsr.2009.06.002. Epub 2009 Sep 10.
Meniscal lesions and isolated anterior cruciate ligament (ACL) knee injuries are common. In 2006, about 130,000 patients were admitted to hospital for meniscal surgery and 35,000 for ACL surgery in France. Surgical techniques and indications have evolved over recent years, and interest in meniscus preservation has increased due to the higher risk of femorotibial osteoarthritis following meniscectomy.
To encourage good practices in meniscal lesions surgery (particularly meniscus preservation) and to clarify indications and techniques in ACL reconstruction surgery.
A systematic review of the literature (1996-2007) was performed. It was submitted to a multidisciplinary working group of experts in the field (n=10) who drafted an evidence report and clinical practice guidelines which were subsequently amended in the light of comments from 50 peer reviewers.
(i) Meniscal repair should only be used to heal peripheral meniscal lesions affecting healthy meniscal tissue (injury) in vascularised areas (red-red zone or red-white zone). The current trend is towards use of hybrid implants (fixation material combined with suture wire) and an exclusively arthroscopic technique. (ii) Traumatic meniscal lesions do not always require a meniscectomy; no surgery or meniscal repair should systematically be considered. (iii) The assessment and management of non-traumatic degenerative meniscal lesions depend on the extent of cartilage damage. (iv) All ACL ruptures do not require reconstructive surgery. The indication for reconstruction is based on symptoms, in particular functional instability. As far as acute ACL injuries are considered, reconstruction by arthroscopy should preferably be delayed to reduce the thromboembolic events or joint stiffness. (v) Bone-tendon-bone graft and hamstring tendon reconstruction give similar results. (vi) Lateral tenodesis should be limited to specific cases.
半月板损伤和孤立的前交叉韧带（ACL）膝关节损伤很常见。2006 年，法国约有 130000 名患者因半月板手术和 35000 名患者因 ACL 手术住院。近年来，手术技术和适应证不断发展，由于半月板切除术后股骨胫骨骨关节炎的风险较高，因此对半月板保留的兴趣增加。
鼓励半月板病变手术（特别是半月板保留）的良好实践，并阐明 ACL 重建手术的适应证和技术。
对文献（1996-2007 年）进行了系统回顾。将其提交给该领域的多学科专家工作组（n=10），专家工作组起草了一份证据报告和临床实践指南，随后根据 50 名同行评审员的意见进行了修订。
（i）半月板修复仅应用于治疗影响健康半月板组织（血管区的红-红区或红-白区）的外周半月板损伤（损伤）。目前的趋势是使用混合植入物（固定材料与缝合线结合）和纯粹的关节镜技术。（ii）创伤性半月板损伤并不总是需要半月板切除术；不应该系统地考虑手术或半月板修复。（iii）非创伤性退行性半月板损伤的评估和管理取决于软骨损伤的程度。（iv）并非所有 ACL 断裂都需要重建手术。重建的适应证基于症状，特别是功能不稳定。就急性 ACL 损伤而言，最好通过关节镜延迟重建以减少血栓栓塞事件或关节僵硬。（v）骨-腱-骨移植物和腘绳肌腱重建的结果相似。（vi）外侧肌腱固定术应限于特定病例。
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