Noyes Frank R, Barber-Westin Sue D, Chen Ryan C
Department of Orthopaedic Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
Instr Course Lect. 2011;60:415-37.
A functional meniscus is critical to the long-term health of the knee joint. The repair of meniscal tears that extend into the central avascular region requires understanding the appropriate indications, contraindications, surgical techniques, and postoperative rehabilitation protocols. An inside-out repair technique using multiple vertical divergent sutures with an accessory posteromedial or posterolateral incision is recommended for optimal stability. In young, active patients, the risk of repair failure and the need for revision are outweighed by the benefit of meniscal preservation. Although many meniscal tears are repairable, not all are salvageable, especially if considerable tissue damage has occurred. The goals of transplantation of human menisci are to restore partial load-bearing meniscal function, decrease patient symptoms, and provide chondroprotective effects. Clinical studies have shown that meniscal transplantation decreases tibiofemoral joint pain in the short term. The procedure remains in an evolving state with an unpredictable long-term outcome; however, most meniscal transplants gradually deteriorate, tear, or shrink in size over time, thereby losing the ability to provide function. The current goal is to provide short-term benefits to the patient until a superior meniscal transplant is clinically available.
功能性半月板对于膝关节的长期健康至关重要。延伸至中央无血管区域的半月板撕裂伤的修复需要了解合适的适应证、禁忌证、手术技术及术后康复方案。为达到最佳稳定性，推荐采用经辅助后内侧或后外侧切口的多垂直发散缝线由内向外修复技术。对于年轻、活跃的患者，半月板保留的益处超过修复失败及翻修的风险。虽然许多半月板撕裂伤可修复，但并非所有都可挽救，尤其是在发生相当程度的组织损伤时。人半月板移植的目标是恢复半月板部分负重功能、减轻患者症状并提供软骨保护作用。临床研究表明，半月板移植可在短期内减轻胫股关节疼痛。该手术仍处于不断发展的状态，长期结果不可预测；然而，大多数半月板移植随着时间推移会逐渐退化、撕裂或缩小，从而失去提供功能的能力。当前目标是在临床上有更好的半月板移植可用之前，为患者提供短期益处。
