Department of Orthopedic Surgery, Korea University School of Medicine, Seoul, Korea.
Clin Orthop Surg. 2012 Jun;4(2):129-33. doi: 10.4055/cios.2012.4.2.129. Epub 2012 May 17.
The purpose of this study was to assess the intra-articular patterns in the rotational deformities of bucket handle meniscal tears (BHMTs) based on arthroscopic findings and their clinical relevance.
From 2004 to 2009, 42 patients with a BHMT diagnosed by magnetic resonance imaging underwent arthroscopic surgery. The arthroscopic data (all procedures were recorded) were evaluated retrospectively, and BHMTs were classified according to the rotational directions of centrally displaced fragments. To assess the reliability of the agreement in this classification, 2 orthopedic surgeons re-classified BHMTs, 1 week after first trial. Intra- and interobserver reliabilities were assessed using kappa statistics. In addition, we address specific tear patterns, associated anterior cruciate ligament injury, medio-lateral difference, reducibility, chronicity, and reparability.
Most of the tears could be categorized into one of 3 morphologic patterns. Of the tears, 4.8% could not be categorized. BHMTs were classified, based on the rotational directions of centrally displaced fragments, as follows; the upward rotation group (type 1), the downward rotation group (type 2) and the reverse group (type 3). The most common intra-articular pattern was type 1 (29 patients, 69%). The occurrence of the other patterns was: type 2 in 7 patients (16.7%), type 3 in 4 patients (9.5%); we were not able to make a classification of type in 2 patients (4.8%). Intra-observer reliability was 0.86 in terms of kappa statistics, which implies almost perfect agreement. Mean interobserver reliability (0.73) showed substantial agreement. Type 1 and 2 tears were easily reduced, whereas all type 3 tears (4/4) needed additional procedures to achieve reduction.
Based on arthroscopic findings, we describe a comprehensive BHMT classification scheme that encompasses 95.2% of all tears. Tear type was correlated with reducibility.
本研究旨在根据关节镜检查结果评估半月板桶柄状撕裂（BHMT）的关节内旋转畸形模式及其临床相关性。
2004 年至 2009 年，42 例经 MRI 诊断为 BHMT 的患者接受了关节镜手术。回顾性评估关节镜数据（所有手术过程均有记录），根据中央移位碎片的旋转方向对 BHMT 进行分类。为了评估该分类的一致性可靠性，2 名骨科医生在首次尝试后 1 周重新分类 BHMT。使用 Kappa 统计评估组内和组间的可靠性。此外，我们还研究了特定的撕裂模式、合并的前交叉韧带损伤、内外侧差异、可还原性、慢性和可修复性。
大多数撕裂可分为 3 种形态学模式之一。4.8%的撕裂无法分类。根据中央移位碎片的旋转方向，BHMT 可分为：上旋组（1 型）、下旋组（2 型）和反转组（3 型）。最常见的关节内模式是 1 型（29 例，69%）。其他模式的发生情况如下：7 例（16.7%）为 2 型，4 例（9.5%）为 3 型；2 例（4.8%）无法进行分类。Kappa 统计的组内可靠性为 0.86，表明几乎完全一致。平均组间可靠性（0.73）显示存在实质性一致。1 型和 2 型撕裂容易复位，而所有 3 型撕裂（4/4）均需要额外的程序才能实现复位。
根据关节镜检查结果，我们描述了一种全面的 BHMT 分类方案，涵盖了 95.2%的所有撕裂。撕裂类型与可还原性相关。
