Complejo Hospitalario de Jaén, Jaén, Spain.
Hospital Universitario Virgen de la Victoria, Málaga, Spain.
Arthroscopy. 2014 Apr;30(4):492-6. doi: 10.1016/j.arthro.2013.12.020.
The purpose of this study was to determine the outcomes after repair of chronic bucket-handle medial meniscal tears by use of magnetic resonance imaging, clinical examination, and patient-reported outcomes.
A retrospective review of patients with chronic bucket-handle medial meniscal tears that had been repaired with meniscal sutures was undertaken. The following criteria for inclusion were adopted: minimum tear length of 2 cm and chronic medial meniscal tear identified at the time of arthroscopy. The tears were susceptible to dislocation with probing. Data collected included demographic, clinical, radiologic, and surgical data. Postoperative healing was assessed with the clinical criteria of Barrett et al. The International Knee Documentation Committee rating, Lysholm score, and Tegner activity level were determined, and postoperative magnetic resonance imaging was used to evaluate healing in accordance with the criteria of Henning et al.
Twenty-four patients fulfilled the inclusion criteria. The mean time from injury to surgery was 10 months (range, 2 to 60 months). Sixteen patients underwent anterior cruciate ligament reconstruction, 1 patient underwent posterior cruciate ligament reconstruction, and 6 patients underwent meniscus repair only. A median of 5 sutures (range, 3 to 6 sutures) were used for repair. Four cases (all of which had undergone meniscus repair only) required revision. Complete healing was achieved in 83% of cases according to the criteria of Barrett et al. The mean follow-up time was 48 months (range, 24 to 112 months). An International Knee Documentation Committee rating of A or B was achieved in the 20 patients who did not require revision. The median Lysholm score was 95 (range, 92 to 100). The median Tegner activity level before injury was 7, and it remained unchanged after surgery in all cases.
This study showed that repair of chronic bucket-handle meniscal tears can lead to good clinical outcomes and a relatively low (17%) failure rate. In addition, repairs of isolated meniscal tears had a significantly higher risk of failure than repairs performed in conjunction with anterior cruciate ligament reconstruction.
Level IV, therapeutic case series.
本研究旨在通过磁共振成像（MRI）、临床检查和患者报告的结果来确定慢性桶柄状内侧半月板撕裂修复后的结果。
对接受半月板缝合修复的慢性桶柄状内侧半月板撕裂患者进行回顾性研究。纳入标准为：至少 2cm 的撕裂长度和关节镜检查时发现的慢性内侧半月板撕裂。探查时撕裂容易脱位。收集的数据包括人口统计学、临床、影像学和手术数据。术后愈合采用 Barrett 等的临床标准进行评估。采用国际膝关节文献委员会（International Knee Documentation Committee，IKDC）评分、Lysholm 评分和 Tegner 活动水平进行评估，并根据 Henning 等的标准进行术后 MRI 评估愈合情况。
24 例患者符合纳入标准。从损伤到手术的平均时间为 10 个月（范围，2 至 60 个月）。16 例患者接受了前交叉韧带重建，1 例患者接受了后交叉韧带重建，6 例患者仅接受了半月板修复。中位数为 5 根缝线（范围，3 至 6 根缝线）用于修复。4 例（均仅行半月板修复）需要翻修。根据 Barrett 等的标准，83%的病例达到完全愈合。平均随访时间为 48 个月（范围，24 至 112 个月）。20 例未行翻修的患者获得 IKDC 评分 A 或 B。Lysholm 评分为 95（范围，92 至 100）。中位数术前 Tegner 活动水平为 7，所有患者术后保持不变。
本研究表明，慢性桶柄状半月板撕裂的修复可带来良好的临床结果和相对较低（17%）的失败率。此外，孤立性半月板撕裂的修复失败风险明显高于与前交叉韧带重建联合进行的修复。
IV 级，治疗性病例系列。
