Navali Amir Mohammad, Aslani Hossein
Department of Orthopedic Surgery, Shahid Gazi Hospital, Tabriz University of Medical Sciences, Tabriz, Iran.
Arch Bone Jt Surg. 2015 Jul;3(3):179-83.
Parts of the implants placed over the meniscus during meniscal repair can wear down the cartilage in the contact zones and cause chronic synovitis. Placing horizontal sutures under the meniscus may overcome this potential hazard. The purpose of this prospective study was to evaluate the midterm results of arthroscopic meniscal repair using submeniscally placed out-in horizontal sutures.
One hundred and three meniscal repairs with submeniscal horizontal out-in technique in 103 patients were performed between 2009 and 2012. Our indications for meniscal repair were all longitudinal tear in red-red and red-white zone with acceptable tissue quality. Clinical evaluation included the Tegner and Lysholm knee scores and clinical success was defined as absence of joint-line tenderness, locking, swelling, and a negative McMurray test.
The average follow-up was 19 months (range, 14 to 40 months). The time interval from injury to meniscal repair ranged from 2 days to 390 days (median, 96 days). At the end of follow-up, the clinical success rate was 86.5%. Fourteen of 103 repaired menisci (13.5%) were considered failures according to Barrett's criteria. The mean Lysholm score significantly improved from 39.6 preoperatively to 84.5 postoperatively (P<0.001). Eighty five patients (82.5%) had an excellent or good result according to Lysholm knee score. Tegner activity score improved significantly (P<0.01) from an average of 3.4 (range, 2-6) preoperatively to 5.9 (range, 5-8) postoperatively. Statistical analysis showed that age, simultaneous anterior cruciate ligament reconstruction, chronicity of injury did not affect the clinical outcome.
Our results showed that acceptable midterm results are expected from submeniscal horizontal out-in repair technique. This technique is cheap, safe and has the advantage of avoiding chondral abrasion caused by solid implants and suture materials placed over the meniscus.
在半月板修复过程中，放置在半月板上方的部分植入物可能会磨损接触区域的软骨并导致慢性滑膜炎。在半月板下方放置水平缝线或许可以克服这一潜在风险。本前瞻性研究的目的是评估使用半月板下穿出水平缝线进行关节镜下半月板修复的中期结果。
2009年至2012年期间，对103例患者进行了103次采用半月板下水平穿出技术的半月板修复手术。我们进行半月板修复的指征均为红-红区和红-白区的纵行撕裂，且组织质量可接受。临床评估包括Tegner和Lysholm膝关节评分，临床成功定义为无关节线压痛、交锁、肿胀以及McMurray试验阴性。
平均随访时间为19个月（范围14至40个月）。从受伤到半月板修复的时间间隔为2天至390天（中位数96天）。随访结束时，临床成功率为86.5%。根据巴雷特标准，103个修复的半月板中有14个（13.5%）被视为失败。Lysholm评分均值从术前的39.6显著提高至术后的84.5（P<0.001）。根据Lysholm膝关节评分，85例患者（82.5%）的结果为优或良。Tegner活动评分从术前平均3.4（范围2 - 6）显著提高（P<0.01）至术后5.9（范围5 - 8）。统计分析表明，年龄、同期前交叉韧带重建、损伤的慢性程度均不影响临床结果。
我们的结果表明，半月板下水平穿出修复技术可获得可接受的中期结果。该技术成本低、安全，且具有避免半月板上方的实心植入物和缝合材料引起软骨磨损的优点。
