Department of Orthopaedic Surgery, Hiratsuka City Hospital, Hiratsuka, Japan.
Arthroscopy. 2010 Feb;26(2):173-83. doi: 10.1016/j.arthro.2009.11.002.
The aim of this study was to compare the results of meniscal repair of the medial meniscus with or without decompression of the posterior segment of the medial meniscus for the treatment of posteromedial tibiofemoral incongruence at full flexion (PMTFI), which induces deformation of the posterior segment on sagittal magnetic resonance imaging (MRI).
For more than 2 years, we followed up 27 patients with PMTFI who were classified into the following 2 groups. Group 1 included 8 patients (5 male joints and 3 female joints) with a medial meniscal tear with instability at the site of the tear who underwent meniscal repair. The mean age was 23.6 years. Group 2 included 19 patients (16 male joints and 3 female joints) who had a meniscal tear with instability at the site of the tear and underwent meniscal repair and decompression. The mean age was 26.5 years. In decompression of the posterior segment, redundant bone tissue on the most proximal part of the medial femoral condyle was excised. The patients were assessed by use of the Lysholm score, sagittal MRI at full flexion, and arthroscopic examination.
There were no statistical differences in mean Lysholm score between the 2 groups before surgery, but the mean score in group 2 was significantly higher than that in group 1 after surgery. Meniscal deformation of the posterior segment at full flexion on MRI disappeared in all cases after decompression. On second-look arthroscopy, the rate of complete healing at the site of the tear was 0% in group 1 but 57% in group 2, and it was significantly different between these groups.
The addition of decompression of the posterior segment of the medial meniscus to meniscal repair of knee joints with PMTFI allowed more room for the medial meniscus to accommodate and improved both function of the knee joint and the rate of success of repair of isolated medial meniscal tears in patients who regularly performed full knee flexion.
本研究旨在比较内侧半月板后段减压与否治疗完全屈膝位时后内侧胫骨股骨不合（PMTFI）所致内侧半月板后段变形的内侧半月板撕裂的修复结果，矢状位 MRI 可见该变形。
我们对 27 例 PMTFI 患者进行了 2 年以上的随访，将其分为以下 2 组。组 1 包括 8 例（5 个男性关节和 3 个女性关节）内侧半月板撕裂伴撕裂处不稳定的患者，行半月板修复术。平均年龄为 23.6 岁。组 2 包括 19 例（16 个男性关节和 3 个女性关节）半月板撕裂伴撕裂处不稳定的患者，行半月板修复和减压术。平均年龄为 26.5 岁。在进行后段减压时，切除股骨内髁近端最突出部分的多余骨组织。采用 Lysholm 评分、完全屈膝位矢状 MRI 及关节镜检查评估患者。
术前 2 组平均 Lysholm 评分无统计学差异，但术后组 2 评分明显高于组 1。MRI 显示完全屈膝位时内侧半月板后段的半月板变形均消失。在二次关节镜检查中，组 1 撕裂处完全愈合率为 0%，组 2 为 57%，两组差异有统计学意义。
在 PMTFI 膝关节的半月板修复中增加内侧半月板后段减压术，可使内侧半月板有更大的容纳空间，改善膝关节功能，提高定期完全屈膝的内侧半月板撕裂修复成功率。
