Spahn Gunter, Plettenberg Holger, Hoffmann Martin, Klemm Holm-Torsten, Brochhausen-Delius Christoph, Hofmann Gunther O
Center of Trauma and Orthopedic Surgery Eisenach, Sophienstr. 16, 99817, Eisenach, Germany.
Jena University Hospital, Trauma Center, Jena, Germany.
Arch Orthop Trauma Surg. 2017 Jun;137(6):837-844. doi: 10.1007/s00402-017-2672-4. Epub 2017 Apr 10.
Are symptomatic tear injuries to the menisci of the knee frequently or always associated with cartilage damage to the corresponding articular surfaces and other joint surfaces, respectively?
A total of 137 patients (medial n = 127; lateral n = 10) underwent a meniscus resection. These patients showed no signs of a clear radiographic arthrosis and no MRI-detectable cartilage lesions > grade II. Traumatic injury was ruled out with a thorough medical history. The indication for operation was made exclusively on the basis of distinct, clinically apparent meniscus signs. In addition to the ICRS classification, all articular surfaces were examined spectroscopically (NIRS, near-infrared spectroscopy).
In 76.6% (n = 105) of all knees examined, clear cartilage damage (ICRS-grade III/IV) was found. For 43.8%, these were in the area of the patella, while for 34.3% they were in the area of the medial femur, and for 17.5%, in the area of the medial tibial plateau. More rarely, this damage was localized to the area of the trochlea (8.8%) or the lateral joint compartment (femoral 2.2%, tibial 15.3%). There were no significant differences between patients with medial or lateral meniscus lesions with respect to the distribution pattern of the joint injuries. During spectroscopic examination, pathological values were demonstrated (objective evidence of cartilage degeneration) in at least one of the examined articular surfaces (media n = 6, range 1-6).
Through our investigations, a high, if not complete, concomitance of degenerative cartilage lesions and degenerative meniscus damage was demonstrated. From this it can be concluded that the entity of "isolated degenerative meniscus damage" clearly does not exist in practice. It is therefore highly probable that degenerative meniscus lesions, as a part of general joint degeneration, are to be interpreted in the context of the development of arthrosis. The practical consequences still are unclear. Patients after partial meniscectomy need a longer follow-up to detect potential cartilage lesions as well as an OA progression.
膝关节半月板的有症状撕裂伤是否经常或总是分别与相应关节面及其他关节面的软骨损伤相关？
共有137例患者（内侧半月板损伤127例；外侧半月板损伤10例）接受了半月板切除术。这些患者无明显的影像学关节病迹象，且MRI未检测到二级以上软骨损伤。通过详细的病史排除创伤性损伤。手术指征完全基于明显的、临床上可见的半月板体征。除了国际软骨修复协会（ICRS）分类外，还对所有关节面进行了光谱检查（近红外光谱，NIRS）。
在所有检查的膝关节中，76.6%（n = 105）发现了明显的软骨损伤（ICRS三级/四级）。其中，43.8%位于髌骨区域，34.3%位于股骨内侧区域，17.5%位于胫骨内侧平台区域。较少见的是，这种损伤局限于滑车区域（8.8%）或外侧关节腔（股骨2.2%，胫骨15.3%）。内侧或外侧半月板损伤患者在关节损伤分布模式上无显著差异。在光谱检查中，至少在一个检查的关节面（中位数n = 6，范围1 - 6）显示出病理值（软骨退变的客观证据）。
通过我们的研究，证明了退变软骨损伤与退变半月板损伤之间存在高度的（即便不是完全的）伴随关系。由此可以得出结论，“孤立的退变半月板损伤”在实际中显然不存在。因此，退变半月板损伤作为一般关节退变的一部分，很可能要在关节病发展的背景下进行解释。实际后果仍不明确。半月板部分切除术后的患者需要更长时间的随访，以检测潜在的软骨损伤以及骨关节炎的进展。
