Dean Chase S, Chahla Jorge, Matheny Lauren M, Mitchell Justin J, LaPrade Robert F
Steadman Philippon Research Institute, Vail, Colorado, USA.
The Steadman Clinic, Vail, Colorado, USA.
Am J Sports Med. 2017 May;45(6):1341-1348. doi: 10.1177/0363546516686968. Epub 2017 Feb 1.
Meniscal repair in the setting of anterior cruciate ligament (ACL) reconstruction has demonstrated superior outcomes compared with isolated meniscal repair. Limited evidence exists for the effects of biological augmentation in isolated meniscal repair, particularly as compared with meniscal repair with concomitant ACL reconstruction. Purpose/Hypothesis: The purpose of this study was to compare the outcomes and survivorship of meniscal repair in 2 cohorts of patients: meniscal repair with biological augmentation using a marrow venting procedure (MVP) of the intercondylar notch, and meniscal repair with concomitant ACL reconstruction. We hypothesized that the clinical outcomes and survivorship of meniscal repair with concomitant ACL reconstruction would be improved compared with meniscal repair with biological augmentation.
Cohort study; Level of evidence, 3.
Inclusion criteria were skeletally mature patients aged ≥16 years who underwent inside-out meniscal repair and either a concomitant MVP of the intercondylar notch or ACL reconstruction. Patients were excluded from this study if they were skeletally immature, underwent meniscus root or radial tear repair, or underwent meniscal repair with concurrent ligamentous reconstruction not limited to the ACL. At the preoperative evaluation and a minimum 2 years after the index meniscal repair procedure, patients were administered a subjective questionnaire. Differences in outcome scores, survivorship, and failure rates between the cohorts were assessed. Failure was defined as reoperation with meniscectomy or revision meniscal repair.
There were 109 patients (52 female, 57 male) who met the inclusion criteria for this study. There were 37 knees in cohort 1 (isolated meniscal repair plus MVP) and 72 knees in cohort 2 (meniscal repair plus ACL reconstruction). The failure status was known in 95 patients, and patient-reported outcome scores were obtained in 89 (82%) patients. Both cohorts demonstrated a significant improvement in all outcome scores, and there was no significant difference in any of the preoperative or postoperative outcome measures. The overall failure rate was 9.5% (9/95). There were 4 (12.9%) failures in cohort 1 and 5 failures (7.8%) in cohort 2, with no significant difference in failures between the cohorts ( P = .429). There was a significant association between failure and female sex ( P = .001).
The most important finding in this study was that there was no difference in outcomes in meniscal repair performed with biological augmentation using an MVP versus that performed concomitantly with ACL reconstruction. The similar outcomes reported for meniscal repair with an MVP and meniscal repair with ACL reconstruction may be partly attributed to biological augmentation.
与单纯半月板修复相比，在前交叉韧带（ACL）重建术中进行半月板修复已显示出更好的效果。关于生物增强在单纯半月板修复中的作用，证据有限，尤其是与同时进行ACL重建的半月板修复相比。目的/假设：本研究的目的是比较两组患者半月板修复的结果和生存率：使用髁间切迹骨髓通气术（MVP）进行生物增强的半月板修复，以及同时进行ACL重建的半月板修复。我们假设，与生物增强的半月板修复相比，同时进行ACL重建的半月板修复的临床结果和生存率会得到改善。
队列研究；证据等级，3级。
纳入标准为年龄≥16岁的骨骼成熟患者，他们接受了由外向内的半月板修复，以及髁间切迹的MVP或ACL重建。如果患者骨骼未成熟、接受了半月板根部或放射状撕裂修复，或接受了不限于ACL的同时韧带重建的半月板修复，则被排除在本研究之外。在术前评估和首次半月板修复手术后至少2年，对患者进行主观问卷调查。评估两组之间结果评分、生存率和失败率的差异。失败定义为半月板切除术或半月板修复翻修的再次手术。
有109例患者（52例女性，57例男性）符合本研究的纳入标准。第1组（单纯半月板修复加MVP）有37个膝关节，第2组（半月板修复加ACL重建）有72个膝关节。95例患者的失败状态已知，89例（82%）患者获得了患者报告的结果评分。两组在所有结果评分上均有显著改善，术前或术后的任何结果指标均无显著差异。总体失败率为9.5%（9/95）。第1组有4例（12.9%）失败，第2组有5例（7.8%）失败，两组之间的失败率无显著差异（P = 0.429）。失败与女性性别之间存在显著关联（P = 0.001）。
本研究最重要的发现是，使用MVP进行生物增强的半月板修复与同时进行ACL重建的半月板修复在结果上没有差异。MVP半月板修复和ACL重建半月板修复报告的相似结果可能部分归因于生物增强。
