Martin-Fuentes Ana Ma, Ojeda-Thies Cristina, Vila-Rico Jesus
Acta Orthop Belg. 2015 Dec;81(4):690-7.
The purpose of this study is to analyze the clinical results of meniscal tears repaired with an all-inside suture with special attention to the results in stable versus anterior cruciate ligament (ACL)-deficient knees.
We studied 45 meniscal tears (32 medial, 13 lateral) repaired in 43 patients using a single all-inside suture system. The patients were divided in two groups and followed-up for at least 12 months. Group A (stable knees with isolated meniscal tears) consisted of 19 patients treated with all-inside sutures. Group B (ACL-deficient knees with meniscal tears) consisted of 24 patients treated with ACL reconstruction together with the meniscal repair. All the meniscal tears were located in red/red (35) or red/white (10) zone. Criteria for clinical success included absence of joint-line tenderness, locking, swelling, and a negative McMurray test. Preoperative and postoperative clinical evaluation also included the Tegner and Lysholm knee scores.
The clinical success rate of the repairs was 86%. According to our criteria, six of 43 repaired menisci (14%) were considered failures. Mean Lysholm scores improved significantly in both groups (58 to 88.20) and the improvement was significantly greater in group B (From 54.47 to 88, p > 0.05). Twenty patients (83.3%) had an excellent or good result in group B and sixteen (84%) in group A, according to the Lysholm knee score.
Our clinical results show that arthroscopic meniscal repair with all-inside devices provided a high rate of meniscus healing and seem to be safe and effective, for isolated meniscal tears as well as for ACL-deficient knees with meniscal tears. Final functional scores were similar for ACL-competent and ACL-deficient knees.
本研究的目的是分析采用全内缝合修复半月板撕裂的临床结果,特别关注稳定膝关节与前交叉韧带(ACL)损伤膝关节的修复结果。
我们研究了43例患者的45处半月板撕裂(32例内侧,13例外侧),采用单一全内缝合系统进行修复。将患者分为两组,随访至少12个月。A组(单纯半月板撕裂的稳定膝关节)由19例接受全内缝合治疗的患者组成。B组(伴有半月板撕裂的ACL损伤膝关节)由24例接受ACL重建及半月板修复的患者组成。所有半月板撕裂均位于红区/红区(35处)或红区/白区(10处)。临床成功标准包括无关节线压痛、交锁、肿胀以及麦氏试验阴性。术前和术后临床评估还包括Tegner和Lysholm膝关节评分。
修复的临床成功率为86%。根据我们的标准,43例修复的半月板中有6例(14%)被视为失败。两组的平均Lysholm评分均显著提高(从58分提高到88.20分),B组的改善更为显著(从54.47分提高到88分,p>0.05)。根据Lysholm膝关节评分,B组20例患者(83.3%)结果为优或良,A组16例患者(84%)结果为优或良。
我们的临床结果表明,使用全内装置进行关节镜下半月板修复可实现较高的半月板愈合率,对于单纯半月板撕裂以及伴有半月板撕裂的ACL损伤膝关节似乎安全有效。ACL功能正常和ACL损伤的膝关节最终功能评分相似。