内侧半月板后角撕裂的外向内修复的神经血管安全性和临床结果。

Neurovascular safety and clinical outcome of outside-in repair of tears of the posterior horn of the medial meniscus.

机构信息

Department of Orthopedics, Ain-Shams University, Cairo, Egypt.

出版信息

Arthroscopy. 2010 Dec;26(12):1648-54. doi: 10.1016/j.arthro.2010.05.018. Epub 2010 Oct 8.

DOI:10.1016/j.arthro.2010.05.018

PMID:20934845

Abstract

PURPOSE

The purpose of this study was to evaluate the safety and clinical outcome of a new posterior approach for the known outside-in technique for repair of tears of the posterior horn of the medial meniscus (PHMM).

METHODS

First, a cadaveric study was performed on 6 cadaveric knees to assess the safety of a point just lateral to the semitendinosus tendon as an entry point for outside-in repair. Dissection was done to measure the clearance of this point to the nearby popliteal bundle and saphenous nerve. A prospective case series study was then performed to assess the clinical outcome of such an approach. We treated 41 consecutive cases with PHMM tears by the outside-in technique using a shuttle relay method through the same point. Clinical assessments, magnetic resonance imaging findings, Lysholm scores, and International Knee Documentation Committee subjective scores were recorded for all patients. After a minimum postoperative period of 2 years, all cases were re-evaluated and re-scored.

RESULTS

The cadaveric study showed a mean clearance distance of 2.4 cm for the popliteal bundle and 4.6 cm for the saphenous nerve. The case series study was done on 41 meniscal repairs; 15 of 41 cases (37%) were performed in conjunction with anterior cruciate ligament reconstruction. There were 22 right knees (54%) and 19 left knees (36%). After a mean follow-up period of 27 months, patients showed a clinical success rate of 88% in terms of disappearance of pain, locking, and swelling, together with improved Lysholm scores (from 34 to 88) and International Knee Documentation Committee scores (from 25 to 88). These improvements were statistically significant (P < .05).

CONCLUSIONS

An outside-in repair technique with a posterior entry central to the semitendinosus tendon was used safely with 88% satisfactory clinical results for treatment of PHMM tears.

LEVEL OF EVIDENCE

Level IV, therapeutic case series.

摘要

目的

本研究旨在评估一种新的后入路方法治疗内侧半月板后角撕裂（PHMM）的安全性和临床结果，该方法是已知的由外向内技术的改良。

方法

首先，我们在 6 具尸体膝关节上进行了一项尸体研究，以评估在半腱肌腱外侧的一个点作为进入点进行由外向内修复的安全性。进行解剖以测量该点与附近的腘绳肌腱和隐神经之间的间隙。然后进行了一项前瞻性病例系列研究，以评估这种方法的临床结果。我们使用穿梭接力法通过同一个点，对 41 例 PHMM 撕裂患者采用由外向内技术进行治疗。所有患者均记录临床评估、磁共振成像（MRI）结果、Lysholm 评分和国际膝关节文献委员会（International Knee Documentation Committee，IKDC）主观评分。所有病例均在术后至少 2 年进行再次评估和重新评分。

结果

尸体研究显示，腘绳肌腱的平均间隙距离为 2.4cm，隐神经为 4.6cm。病例系列研究共纳入 41 例半月板修复患者；其中 15 例（37%）患者同时行前交叉韧带重建术。右侧膝关节 22 例（54%），左侧膝关节 19 例（36%）。平均随访 27 个月后，患者疼痛、交锁和肿胀消失，Lysholm 评分（从 34 分提高至 88 分）和 IKDC 评分（从 25 分提高至 88 分）改善，临床成功率为 88%。这些改善具有统计学意义（P <.05）。