Feucht Matthias J, Bigdon Sebastian, Bode Gerrit, Salzmann Gian M, Dovi-Akue David, Südkamp Norbert P, Niemeyer Philipp
Department of Orthopedic Surgery and Traumatology, Freiburg University Hospital, Albert Ludwigs University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany.
J Orthop Surg Res. 2015 Mar 18;10:34. doi: 10.1186/s13018-015-0184-x.
The pattern of lateral meniscus tears observed in anterior cruciate ligament (ACL)-injured subjects varies greatly and determines subsequent management. Certain tear patterns with major biomechanical consequences should be repaired in a timely manner. Knowledge about risk factors for such tears may help to identify patients in the early posttraumatic phase and subsequently may improve clinical results.
A database of 268 patients undergoing primary ACL reconstruction was used to identify all patients with isolated ACL tears and patients with an associated tear of the lateral meniscus. Patients who underwent surgery >6 months after the injury were excluded. Based on the arthroscopic appearance of the lateral meniscus, patients were assorted to one of three groups: 'no tear,' 'minor tear,' and 'major tear.' Tear patterns defined as major included root tears, complete radial tears, and unstable longitudinal tears including bucket-handle tears. Univariate analysis was performed by comparing the three groups with regard to gender, age, height, weight, BMI, type of injury (high-impact sport, low-impact sport, and not sports related), and mechanism of injury (non-contact vs. contact). Multivariate logistic regression was carried out to identify independent risk factors for minor and major meniscal tears and to calculate odds ratios (OR).
Two hundred fifteen patients met the inclusion and exclusion criteria. Of those, 56% had isolated ACL tears, 27% had associated minor tears, and 17% had associated major tears of the lateral meniscus. Univariate analysis revealed significant differences between the three groups for gender (p = 0.002), age groups (p = 0.026), and mechanism of injury (p < 0.001). A contact injury mechanism was a risk factor for minor tears (OR: 4.28) and major tears (OR: 18.49). Additional risk factors for major tears were male gender (OR: 7.38) and age <30 years (OR: 5.85).
Male patients, patients <30 years, and particularly patients who sustained a contact injury have a high risk for an associated major lateral meniscus tear. Special attention is therefore necessary in those patients and early referral to magnetic resonance imaging and/or arthroscopy is recommended to allow meniscus repair in a timely manner.
在前交叉韧带（ACL）损伤患者中观察到的外侧半月板撕裂模式差异很大，并决定了后续的治疗方案。某些具有重大生物力学后果的撕裂模式应及时修复。了解此类撕裂的危险因素可能有助于在创伤后早期识别患者，进而改善临床治疗效果。
使用一个包含268例行初次ACL重建患者的数据库，以识别所有孤立性ACL撕裂患者以及伴有外侧半月板撕裂的患者。排除受伤后6个月以上接受手术的患者。根据外侧半月板的关节镜表现，将患者分为三组之一：“无撕裂”、“轻度撕裂”和“重度撕裂”。定义为重度的撕裂模式包括根部撕裂、完全放射状撕裂以及不稳定的纵向撕裂，包括桶柄状撕裂。通过比较三组患者的性别、年龄、身高、体重、BMI、损伤类型（高冲击性运动、低冲击性运动以及与运动无关）和损伤机制（非接触性与接触性）进行单因素分析。进行多因素逻辑回归以确定轻度和重度半月板撕裂的独立危险因素，并计算比值比（OR）。
215例患者符合纳入和排除标准。其中，56%为孤立性ACL撕裂，27%伴有轻度撕裂，17%伴有外侧半月板重度撕裂。单因素分析显示，三组患者在性别（p = 0.002）、年龄组（p = 0.026）和损伤机制（p < 0.001）方面存在显著差异。接触性损伤机制是轻度撕裂（OR：4.28）和重度撕裂（OR：18.49）的危险因素。重度撕裂的其他危险因素为男性（OR：7.38）和年龄<30岁（OR：5.85）。
男性患者、年龄<30岁的患者，尤其是遭受接触性损伤的患者，发生外侧半月板重度撕裂的风险较高。因此，这些患者需要特别关注，建议早期转诊至磁共振成像和/或关节镜检查，以便及时进行半月板修复。
