Matava Matthew J, Kim Young-Mo
Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, USA.
Knee. 2011 Jan;18(1):62-5. doi: 10.1016/j.knee.2010.01.007. Epub 2010 Mar 3.
It has been theorized that a traumatic tibial avulsion fracture of the posterior root of the medial meniscus (MM) is the cause of the so-called meniscus ossicle (MO). We report the delayed appearance of a tibial avulsion fracture of the posterior root of the MM after a valgus, twisting injury in a 12-year-old boy with open physes. Magnetic resonance imaging (MRI) scans performed 3 days after the injury did not demonstrate a definitive tibial avulsion fracture of the posterior root of the MM; whereas, a repeat MRI for 3 months post-injury did. Medial extrusion of the MM was also noted on the 3 month MRI. Arthroscopic reattachment of the avulsed posterior root of the MM using a trans-physeal nonabsorbable suture tied over a proximal tibia staple was performed. Follow-up MRI at 6 months postoperatively demonstrated healing of the tibial avulsion fracture of the posterior root of the MM in an anatomic position. The patient had a complete resolution of symptoms and there was no angular deformity or limb-length discrepancy at 2 years postoperatively. To our knowledge, this is the first report describing a tibial avulsion fracture of the posterior root of the MM in a skeletally-immature patient successfully treated by a trans-physeal arthroscopic suture. This case also illustrates the development of the MO of the posterior root of the MM.
理论上认为，内侧半月板（MM）后根部的创伤性胫骨撕脱骨折是所谓半月板小骨（MO）的病因。我们报告了一名12岁开放性骨骺男孩在遭受外翻扭转损伤后，MM后根部胫骨撕脱骨折延迟出现的情况。受伤3天后进行的磁共振成像（MRI）扫描未显示MM后根部明确的胫骨撕脱骨折；而受伤后3个月的重复MRI显示有骨折。3个月的MRI还显示MM有内侧移位。采用经骨骺不可吸收缝线固定于胫骨近端钉上的方法，对撕脱的MM后根部进行了关节镜下重新附着。术后6个月的随访MRI显示MM后根部胫骨撕脱骨折在解剖位置愈合。患者症状完全缓解，术后2年无角状畸形或肢体长度差异。据我们所知，这是第一份描述经骨骺关节镜缝合成功治疗骨骼未成熟患者MM后根部胫骨撕脱骨折的报告。该病例还说明了MM后根部MO的形成过程。
