Brucker Peter U, von Campe Arndt, Meyer Dominik C, Arbab Dariusch, Stanek Laila, Koch Peter P
Orthopaedic Department, Balgrist University Hospital, University of Zurich, Switzerland.
Knee. 2011 Dec;18(6):396-401. doi: 10.1016/j.knee.2010.11.007. Epub 2011 Apr 13.
The long-term results over 20 years following meniscal repair in stable knees have not been described yet. The objective was therefore to analyze the clinical and radiological outcomes of successful, isolated, open meniscal repairs with an intact ACL after a mean follow-up of 20.6 years (range, 16-25) retrospectively in 26 patients. Clinical evaluation included objective (Lysholm, IKDC, Tegner) and subjective scores. Standard radiological assessment according to Ahlbäck's osteoarthritis classification and weight-bearing full-leg radiography for alignment were performed. Eight patients were excluded due to a re-rupture of the meniscus. In the 18 remaining patients (12 male, 6 female), the mean Lysholm and IKDC score was 97.8 points (range, 85-100) and 93% (range, 77-100) at the most recent follow-up, respectively. The Tegner activity scale averaged 4.2 (range, 3-7). Subjectively, 13 patients rated their outcome excellent, 4 good, and 1 fair. The radiological evaluation demonstrated an average development of "+1" grade (range, 0-"+2") osteoarthritic changes versus preoperatively; however, the contralateral healthy knee also revealed comparable (on average "+1" grade) degenerative changes reflecting natural history. The alignment was not significantly different between the operated and the contralateral leg. Overall, isolated open meniscal repair in stableness has the potential of a successful surgery with good to excellent long-term results. The development of osteoarthritic changes within the femorotibial compartments is mild and comparable to contralateral and the alignment of the axis is preserved. Therefore, repair of a ruptured meniscus is recommended whenever possible, even in isolated meniscal tears. However, a re-rupture rate of approximately 30% in isolated meniscal tears has to be acknowledged, which still reflects the need for biological enhancement of meniscal healing.
关于稳定膝关节半月板修复术后20年的长期结果尚未见报道。因此，本研究的目的是对26例患者进行回顾性分析，这些患者在平均随访20.6年（范围16 - 25年）后，接受了成功的、孤立的、开放性半月板修复术，且前交叉韧带完整。临床评估包括客观评分（Lysholm、IKDC、Tegner）和主观评分。根据Ahlbäck骨关节炎分类标准进行标准放射学评估，并进行负重全腿X线摄影以评估对线情况。8例因半月板再次破裂被排除。在其余18例患者（12例男性，6例女性）中，最近一次随访时，Lysholm和IKDC评分的平均值分别为97.8分（范围85 - 100分）和93%（范围77 - 100%）。Tegner活动量表平均分为4.2（范围3 - 7）。主观上，13例患者将其结果评为优秀，4例为良好，1例为一般。放射学评估显示，与术前相比，平均出现了“+1”级（范围0 - “+2”级）骨关节炎改变；然而，对侧健康膝关节也显示出类似的（平均“+1”级）退变改变，反映了自然病程。手术侧与对侧腿的对线情况无显著差异。总体而言，稳定状态下的孤立开放性半月板修复术有可能取得成功，长期效果良好至优秀。股胫关节间隙内骨关节炎改变的发展较为轻微，与对侧相当，且轴的对线得以保留。因此，即使是孤立的半月板撕裂，也建议尽可能进行破裂半月板的修复。然而，必须认识到孤立半月板撕裂的再次破裂率约为30%，这仍然表明需要通过生物学方法促进半月板愈合。
