Demange Marco Kawamura, Gobbi Riccardo Gomes, Camanho Gilberto Luis
Institute of Orthopaedic Surgery - Hospital das Clínicas, Faculty of Medicine, University of São Paulo, Rua Ouvidio Pires de Campos, 333, Cerqueira Cesar, São Paulo, SP, Brazil.
Int Orthop. 2016 Feb;40(2):399-405. doi: 10.1007/s00264-015-3010-5. Epub 2015 Oct 6.
The purpose of this study was to describe the clinical outcomes of partial meniscectomy in patients with "fatigue meniscal tear", which presents as a non-traumatic tear with abrupt onset of symptoms of a radial tear in the transition between the middle and posterior thirds of the meniscus.
We prospectively followed 71 patients with "fatigue meniscal tear" (41 women and 30 men, mean age of 63 years, SD 6.9 years) recruited among 497 patients with isolated medial meniscal lesions treated between January 2006 and June 2011. Inclusion criteria were spontaneous abrupt onset knee pain, minor or no trauma, no radiographic or MRI osteoarthritis, no bone oedema, pre-operative magnetic resonance image of medial meniscus tear, and arthroscopic evaluation demonstrating radial or vertical flap tear in the body to posterior horn junction of the medial meniscus. We followed all patients for a minimum of two years and reviewed their clinical symptoms, physical exam, functional outcome, and patient satisfaction at last follow-up.
The average follow-up was 4.2 years, with a minimum follow-up of two years. Among the 71 patients, there were 59 (83.1 %) good or excellent results and 12 (16.9 %) poor results. These 12 patients demanded further treatment because of persistent pain, with three of the patients developing subchondral bone fracture. All patient complaints and poor outcomes could be identified in the initial six months after surgery. There was no gender difference in the subgroup analysis.
Our findings indicate that patients with "fatigue meniscal tear" benefit from arthroscopic partial meniscectomy, with only 16.9 % reporting unfavourable results.
IV, Cohort study or case series.
本研究旨在描述“疲劳性半月板撕裂”患者行部分半月板切除术的临床疗效。“疲劳性半月板撕裂”表现为非创伤性撕裂，症状突然发作，撕裂位于半月板中后三分之一交界处，呈放射状撕裂。
我们前瞻性地随访了71例“疲劳性半月板撕裂”患者（41例女性，30例男性，平均年龄63岁，标准差6.9岁），这些患者是从2006年1月至2011年6月间接受治疗的497例孤立性内侧半月板损伤患者中招募的。纳入标准为自发突然发作的膝关节疼痛、轻微或无创伤、无影像学或MRI显示的骨关节炎、无骨水肿、术前内侧半月板撕裂的磁共振图像，以及关节镜评估显示内侧半月板体部至后角交界处为放射状或垂直瓣状撕裂。我们对所有患者进行了至少两年的随访，并在最后一次随访时复查了他们的临床症状、体格检查、功能结局和患者满意度。
平均随访时间为4.2年，最短随访时间为两年。71例患者中，59例（83.1%）结果良好或优秀，12例（16.9%）结果不佳。这12例患者因持续疼痛需要进一步治疗，其中3例患者发生了软骨下骨骨折。所有患者的主诉和不良结局均可在术后最初6个月内发现。亚组分析中无性别差异。
我们的研究结果表明，“疲劳性半月板撕裂”患者可从关节镜下部分半月板切除术中获益，只有16.9%的患者报告结果不佳。
IV级，队列研究或病例系列。
