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半月板同种异体移植:内侧与外侧手术的比较。

Meniscus allograft transplantation: a comparison of medial and lateral procedures.

机构信息

Kee Yun Chung, Department of Orthopaedic Surgery, School of Medicine, Kyung Hee University, 1 Hoegi-Dong, Dongdaemoon-Gu, Seoul 130-702, Korea.

出版信息

Am J Sports Med. 2014 Jan;42(1):200-7. doi: 10.1177/0363546513509057. Epub 2013 Nov 8.

Abstract

BACKGROUND

Because of the anatomic and biomechanical differences between the lateral and medial menisci, it is believed that the indications, combined injuries, techniques, and outcomes of the 2 meniscus allograft transplantation (MAT) procedures may be different.

HYPOTHESIS

Medial meniscus transplantation (medial group) usually combines concomitant surgeries, such as anterior cruciate ligament (ACL) reconstruction, so the medial group will have worse clinical results than the lateral group (lateral meniscus transplantation).

STUDY DESIGN

Cohort study; Level of evidence, 3.

METHODS

A retrospective study was conducted on 91 patients who underwent MAT (lateral group, n = 56; medial group, n = 35). There were 33 patients with an absence of a concurrent injury (isolated group) and 58 patients with the presence of a concurrent injury (combined group). The mean follow-up was 40 months (range, 24-125 months). Clinical outcomes for range of motion (ROM), visual analog scale (VAS) for pain score, International Knee Documentation Committee (IKDC) subjective score, Lysholm score, and Tegner activity score were evaluated, and an objective evaluation was performed using magnetic resonance imaging (MRI) and second-look arthroscopic surgery.

RESULTS

At final follow-up, the mean results for ROM, VAS score, IKDC subjective score, Lysholm score, Tegner activity score, and patient subjective satisfaction were not statistically different between the lateral and medial groups (P > .05). The VAS and Lysholm scores of the isolated group were significantly better than those of the combined group. Follow-up MRI was performed on 35 patients (24 in the lateral group and 11 in the medial group). Mean graft extrusion was 1.7 mm in the lateral group and 2.6 mm in the medial group (P = .075). The relative percentage of extrusion was 19.4% in the lateral group and 32.0% in the medial group (P = .011). Anterior cruciate ligament reconstruction occurred more commonly in the medial group, and cartilage procedures occurred more commonly in the lateral group.

CONCLUSION

The clinical results of the lateral group were not different from those of the medial group. More graft extrusion was found in the medial group on MRI, and second-look arthroscopic surgery results of the lateral group were not as good as those of the medial group. The VAS and Lysholm scores of the combined group were worse than those of the isolated group. With regard to concomitant surgery, ACL reconstruction was most common in the medial group and cartilage procedures in the lateral group.

摘要

背景

由于外侧和内侧半月板在解剖和生物力学上存在差异,因此人们认为两种半月板同种异体移植(MAT)手术的适应证、合并损伤、技术和结果可能不同。

假设

内侧半月板移植(内侧组)通常与前交叉韧带(ACL)重建等同时进行手术,因此内侧组的临床结果将比外侧组(外侧半月板移植)差。

研究设计

队列研究;证据水平,3 级。

方法

对 91 例行 MAT(外侧组,n=56;内侧组,n=35)的患者进行回顾性研究。其中 33 例患者无合并损伤(单纯组),58 例患者有合并损伤(合并组)。平均随访时间为 40 个月(范围,24-125 个月)。评估了关节活动度(ROM)、疼痛视觉模拟评分(VAS)、国际膝关节文献委员会(IKDC)主观评分、Lysholm 评分和 Tegner 活动评分等临床结果,并通过磁共振成像(MRI)和二次关节镜检查进行了客观评估。

结果

末次随访时,外侧组和内侧组的 ROM、VAS 评分、IKDC 主观评分、Lysholm 评分、Tegner 活动评分和患者主观满意度的平均结果差异无统计学意义(P>.05)。单纯组的 VAS 和 Lysholm 评分明显优于合并组。对 35 例患者(外侧组 24 例,内侧组 11 例)进行了随访 MRI 检查。外侧组的平均移植物挤出为 1.7mm,内侧组为 2.6mm(P=0.075)。外侧组的挤出相对百分比为 19.4%,内侧组为 32.0%(P=0.011)。内侧组更常行 ACL 重建,外侧组更常行软骨手术。

结论

外侧组的临床结果与内侧组无差异。MRI 显示内侧组移植物挤出较多,外侧组二次关节镜检查结果不如内侧组。合并组的 VAS 和 Lysholm 评分较单纯组差。关于同时进行的手术,内侧组最常见的是 ACL 重建,而外侧组最常见的是软骨手术。

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