Department of Orthopaedic Surgery, Yonsei Sarang Hospital, Seoul, Republic of Korea.
Am J Sports Med. 2012 May;40(5):1138-43. doi: 10.1177/0363546511435622. Epub 2012 Feb 7.
Repair of a posterior root tear of the medial meniscus (MRT) decreases peak contact pressure by restoring hoop tension and is expected to prevent progression to osteoarthritis.
The purposes of this study were (1) to report the clinical and magnetic resonance imaging (MRI) results of arthroscopic pull-out repair of the MRT and (2) to identify prognostic factors of poor outcome.
Case series; Level of evidence, 4.
Fifty-one patients (47 women, 4 men) who underwent arthroscopic pull-out repair of the MRT by a single surgeon were enrolled. Mean follow-up after surgery was 33 months (range, 24-44 months). To identify factors affecting final outcome, patient-specific factors, such as gender, age, body mass index, meniscus extrusion, extrusion increase, subchondral edema, degree of varus alignment (<5° or >5°), and cartilage status in the medial compartment (Outerbridge grade 1 or 2 lesion vs grade 3 or 4 lesion), were investigated. Final clinical outcomes were determined using a visual analog scale (VAS) for pain and patient satisfaction scores, American Knee Society (AKS) scores, and Lysholm scores, and MRI outcomes were determined by evaluating meniscus extrusion and articular cartilage status. Multiple regression analysis was performed to identify variables that independently affected clinical and MRI-determined outcomes.
All clinical outcome measures significantly improved after surgery. Patients with Outerbridge grade 3 or 4 chondral lesions had poorer results than those with grade 1 or 2 lesions in terms of AKS function and Lysholm scores. Patients with varus alignment of >5° had poorer results than those with varus alignment of <5° in terms of VAS satisfaction, AKS function, and Lysholm scores. Mean meniscus extrusion increased from 3.6 mm preoperatively to 5.0 mm postoperatively. Chondral lesions progressed in 3 (9.7%) of 31 patients. Preoperative meniscus extrusion was found to be positively correlated with final extrusion.
At a mean follow-up of 33 months after pull-out repair, extrusion of the meniscus was found to have progressed. Nevertheless, this technique provided patients with a clinical benefit. Outerbridge grade 3 or 4 chondral lesions and varus alignment of >5° were found to independently predict an inferior clinical outcome.
内侧半月板后根部撕裂（MRT）的修复通过恢复环张力来降低峰值接触压力，有望预防向骨关节炎进展。
本研究的目的是（1）报告关节镜下 MRT 抽出修复的临床和磁共振成像（MRI）结果，（2）确定不良预后的预测因素。
病例系列；证据水平，4 级。
纳入 51 例（47 名女性，4 名男性）由同一位医生进行关节镜下 MRT 抽出修复的患者。术后平均随访 33 个月（24-44 个月）。为了确定影响最终结果的因素，研究人员调查了患者的特定因素，如性别、年龄、体重指数、半月板挤出、挤出增加、软骨下水肿、内翻角度（<5°或>5°）以及内侧间室的软骨状态（Outerbridge 分级 1 或 2 病变与 3 或 4 级病变）。最终的临床结果通过疼痛和患者满意度评分、美国膝关节协会（AKS）评分和 Lysholm 评分的视觉模拟量表（VAS）进行评估，MRI 结果通过评估半月板挤出和关节软骨状况进行评估。采用多元回归分析确定独立影响临床和 MRI 确定的结果的变量。
所有临床评估指标在术后均显著改善。软骨 Outerbridge 分级为 3 或 4 级的患者在 AKS 功能和 Lysholm 评分方面的结果比 1 或 2 级的患者差。内翻角度>5°的患者在 VAS 满意度、AKS 功能和 Lysholm 评分方面的结果比内翻角度<5°的患者差。半月板挤出的平均值从术前的 3.6mm 增加到术后的 5.0mm。31 例患者中有 3 例（9.7%）出现软骨病变进展。术前半月板挤出与最终挤出呈正相关。
在接受抽出修复后的平均 33 个月随访时，发现半月板挤出有进展。尽管如此，这种技术仍为患者带来了临床获益。Outerbridge 分级 3 或 4 级软骨病变和内翻角度>5°独立预测较差的临床结果。
