Krych Aaron J, Reardon Patrick J, Johnson Nick R, Mohan Rohith, Peter Logan, Levy Bruce A, Stuart Michael J
Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
Knee Surg Sports Traumatol Arthrosc. 2017 Feb;25(2):383-389. doi: 10.1007/s00167-016-4359-8. Epub 2016 Oct 19.
Medial meniscus posterior root tears (MMPRTs) are a significant source of pain and dysfunction, but little is known about the natural history and outcome and for non-operative management of these lesions. The purpose of this study was to evaluate (1) the mid-term clinical and radiographic outcomes of non-operative treatment of MMPRTs and (2) risk factors for worse outcomes.
A retrospective review was performed for patients with symptomatic, unrepaired MMPRTs and a minimum 2-year follow-up for IKDC and Tegner outcome scores. Baseline and final radiographs were reviewed and graded according to Kellgren-Lawrence scores. Baseline MRIs were reviewed for the presence of meniscal extrusion, subchondral oedema, and insufficiency fractures. Failure was defined as conversion to arthroplasty or severely abnormal patient subjective IKDC score.
Fifty-two patients (21M:31F) with a mean age of 58 ± 10 years were diagnosed with symptomatic MMPRTs clinically and confirmed by MRI and followed for a mean of 62 ± 30 months. Sixteen patients (31 %) underwent total knee arthroplasty at a mean of 30 ± 32 months after diagnosis with higher Kellgren-Lawrence grades associated with increased rates of arthroplasty (p = 0.01). Mean IKDC scores for the remaining patients were 61.2 ± 21 with significantly lower scores in females compared to males (75 ± 12 vs. 49 ± 20; p = 0.03). Mean Kellgren-Lawrence grades and rates of arthritis progressed over time on radiographs (1.5 ± 0.7 vs. 2.4 ± 1.0; p < 0.001 and 78 % vs. 51 %; p = 0.01). Overall, 87 % of patients failed non-operative treatment.
Non-operative treatment of medial meniscus posterior horn root tears is associated with poor clinical outcome, worsening arthritis, and a relatively high rate of arthroplasty at 5-year follow-up. Female gender was associated with lower subjective scores and higher rate of arthroplasty. The current study provides a natural history benchmark for clinical outcomes that can be expected in patients with medial meniscus posterior horn root tears undergoing non-operative treatment and helps in counselling patients with these types of injuries.
IV.
内侧半月板后根撕裂（MMPRTs）是疼痛和功能障碍的重要原因，但对于这些损伤的自然病史、结局以及非手术治疗知之甚少。本研究的目的是评估（1）MMPRTs非手术治疗的中期临床和影像学结局，以及（2）预后较差的危险因素。
对有症状、未修复的MMPRTs患者进行回顾性研究，并对IKDC和Tegner结局评分进行至少2年的随访。根据Kellgren-Lawrence评分对基线和最终的X线片进行评估和分级。对基线MRI进行评估，以确定是否存在半月板挤出、软骨下水肿和不全骨折。失败定义为转为关节置换术或患者主观IKDC评分严重异常。
52例患者（男21例，女31例），平均年龄58±10岁，临床诊断为有症状的MMPRTs，并经MRI证实，平均随访62±30个月。16例患者（31%）在诊断后平均30±32个月接受了全膝关节置换术，Kellgren-Lawrence分级越高，关节置换率越高（p = 0.01）。其余患者的平均IKDC评分为61.2±21，女性患者的评分显著低于男性（75±12对49±20；p = 0.03）。X线片显示，平均Kellgren-Lawrence分级和关节炎发生率随时间推移而进展（1.5±0.7对2.4±1.0；p < 0.001，78%对51%；p = 0.01）。总体而言，87%的患者非手术治疗失败。
内侧半月板后角根撕裂的非手术治疗与较差的临床结局、关节炎恶化以及5年随访时相对较高的关节置换率相关。女性性别与较低的主观评分和较高的关节置换率相关。本研究为接受非手术治疗的内侧半月板后角根撕裂患者的临床结局提供了一个自然病史基准，并有助于为这类损伤的患者提供咨询。
IV级
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