Cincinnati Sportsmedicine Research and Education Foundation, Cincinnati, Ohio, USA.
Am J Sports Med. 2011 May;39(5):1008-17. doi: 10.1177/0363546510392014. Epub 2011 Jan 29.
A prospective longitudinal investigation was conducted to determine the long-term outcome of single longitudinal meniscal repairs extending into the central avascular region in patients aged 20 years or younger.
To determine the long-term success rate and reoperation rate of meniscal repairs extending into the avascular zone.
Case series; Level of evidence, 4.
Thirty-three meniscal repairs were performed using an inside-out multiple vertical divergent suture technique. A concomitant anterior cruciate ligament reconstruction was done in 18 patients. The mean follow-up was 16.8 years (range, 10.1-21.9 years). The long-term success rate was determined in 29 repairs (88%) by the presence of normal or nearly normal parameters from 2 validated knee rating systems, assessment of magnetic resonance imaging and weightbearing posteroanterior radiographs by independent physicians, and follow-up arthroscopy when required. A 3 Tesla magnetic resonance imaging scanner with cartilage-sensitive pulse sequences was used, and T2 mapping was performed. A comparison was made between the short-term (mean, 4 years) and long-term outcomes.
Eighteen (62%) of the meniscal repairs had normal or nearly normal characteristics in all of the parameters assessed. Six repairs (21%) required partial arthroscopic resection, 2 had loss of joint space on radiographs, and 3 that were asymptomatic failed according to magnetic resonance imaging criteria, for a total of 11 documented failures (38%). There was no significant difference in the mean articular cartilage T2 scores in the healed menisci between the involved and contralateral tibiofemoral compartments in the same knee. There were no significant differences between short- and long-term evaluations for pain, swelling, jumping, patient knee condition rating, or the overall Cincinnati rating score.
A chondroprotective joint effect was demonstrated in the healed menisci repairs, which warrants the procedure in select patients. The long-term evaluation of the anterior cruciate ligament-reconstructed knees with concurrent successful meniscal repairs demonstrated a low rate of radiographic arthritis.
本前瞻性纵向研究旨在确定 20 岁或以下患者的半月板单一纵向修复延伸至中央无血管区的长期结果。
确定半月板修复延伸至无血管区的长期成功率和再次手术率。
病例系列；证据水平，4 级。
33 例半月板撕裂采用内侧多垂直发散缝线技术进行修复。18 例患者同时行前交叉韧带重建。平均随访 16.8 年（范围，10.1-21.9 年）。通过 2 种经验证的膝关节评分系统、独立医生评估的磁共振成像和负重前后位 X 线片以及必要时的随访关节镜检查，确定 29 例（88%）修复的长期成功率。使用 3T 磁共振成像扫描仪和软骨敏感脉冲序列进行 T2 图谱分析。比较了短期（平均 4 年）和长期结果。
18 例（62%）半月板修复在所有评估参数中均具有正常或接近正常的特征。6 例（21%）需要部分关节镜切除，2 例放射学上关节间隙丢失，3 例无症状但根据磁共振成像标准失败，总共有 11 例记录的失败（38%）。同一膝关节受累和对侧胫股关节间愈合半月板的关节软骨 T2 评分无显著差异。短期和长期评估在疼痛、肿胀、跳跃、患者膝关节状况评分或整体辛辛那提评分方面无显著差异。
在愈合的半月板修复中显示出软骨保护关节的效果，这证明了在选择患者时进行该手术是合理的。对同时成功进行半月板修复的前交叉韧带重建膝关节进行长期评估，显示放射学关节炎发生率较低。
