年轻患者水平半月板撕裂的开放式半月板修复的临床结果。
Clinical outcomes of open meniscal repair of horizontal meniscal tears in young patients.
机构信息
Orthopedic Department, Centre Hospitalier de Versailles, Versailles-Saint Quentin University, 177, rue de Versailles, 78157 Le Chesnay, France.
出版信息
Knee Surg Sports Traumatol Arthrosc. 2013 Jul;21(7):1530-3. doi: 10.1007/s00167-012-2099-y. Epub 2012 Jun 14.
PURPOSE
Symptomatic horizontal meniscal tears in young patients are a singular entity. The extent of the lesion is often large, without any injury to the knee. The meniscal tissue might be degenerative. However, a complete resection of the lesion would result in a subtotal meniscectomy. The purpose of this study was to consider the use of a meniscal repair in such patients in order to close the horizontal cleavage extending up to the avascular zone. The hypothesis was that the clinical outcomes after open meniscal repair of horizontal tears are good with a low rate of secondary meniscectomy.
METHODS
Between 1998 and 2006, 28 patients (30 knees) underwent an open meniscal repair to treat symptomatic horizontal meniscal tears [6 women and 22 men, median age 25 years (16-44 years)]. The duration of symptoms was at least 12 weeks (12-72 weeks). Open meniscal repair was performed following arthroscopy. There were 14 medial and 7 lateral menisci, 10 grade 3 tears, and 11 grade 2 tears. If present (15 cases), meniscal cysts were removed using the same approach. Clinical outcomes were evaluated using KOOS and IKDC scores. The return to sporting activities and the need for a secondary meniscectomy were also assessed.
RESULTS
Twenty-one patients were evaluated at a median follow-up of 40 months (24-101 months). Twenty returned to their preinjury level of sporting activity. The median KOOS score was 92 ± 12.9. The median subjective IKDC score was 89 ± 14.1. There were four secondary meniscectomies.
CONCLUSIONS
Open meniscal repair of complex horizontal tears extending into the avascular zone was effective at midterm follow-up in young and active patients. The meniscus was preserved in 80 % of cases. Functional results deteriorated in those older than 30 years. This entity should be differentiated from degenerative meniscal tears that often occur in patients over 50, which may be associated with osteoarthritis.
LEVEL OF EVIDENCE
Retrospective study, Level IV.
目的
年轻患者的有症状水平半月板撕裂是一种单一的实体。病变的范围往往很大，没有任何膝关节损伤。半月板组织可能是退行性的。然而，完全切除病变会导致半月板次全切除术。本研究的目的是考虑在这些患者中使用半月板修复术，以便闭合延伸至无血管区的水平撕裂。假设是，水平撕裂的开放式半月板修复后的临床结果良好，继发性半月板切除术的发生率较低。
方法
1998 年至 2006 年间，28 名患者（30 膝）接受了开放式半月板修复术治疗有症状的水平半月板撕裂[6 名女性和 22 名男性，中位年龄 25 岁（16-44 岁）]。症状持续时间至少为 12 周（12-72 周）。开放式半月板修复是在关节镜检查后进行的。有 14 个内侧和 7 个外侧半月板，10 个 3 级撕裂，11 个 2 级撕裂。如果存在（15 例），使用相同的方法切除半月板囊肿。使用 KOOS 和 IKDC 评分评估临床结果。还评估了重返运动活动和需要进行二次半月板切除术的情况。
结果
21 名患者在中位随访 40 个月（24-101 个月）时进行了评估。20 名患者恢复到受伤前的运动水平。KOOS 评分中位数为 92±12.9。主观 IKDC 评分中位数为 89±14.1。有 4 例进行了二次半月板切除术。
结论
在年轻和活跃的患者中，中短期随访时，开放式复杂水平撕裂延伸至无血管区的半月板修复是有效的。在 80%的病例中保留了半月板。年龄大于 30 岁的患者功能结果恶化。这种情况应与常发生在 50 岁以上患者的退行性半月板撕裂相区别，后者可能与骨关节炎有关。
证据水平
回顾性研究，IV 级。
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