Bisson Leslie J, Kluczynski Melissa A, Wind William M, Fineberg Marc S, Bernas Geoffrey A, Rauh Michael A, Marzo John M, Zhou Zehua, Zhao Jiwei
1The State University of New York at Buffalo, Buffalo, New York.
J Bone Joint Surg Am. 2017 Jul 5;99(13):1078-1085. doi: 10.2106/JBJS.16.00855.
It is unknown whether unstable chondral lesions observed during arthroscopic partial meniscectomy (APM) require treatment. We examined differences at 1 year with respect to knee pain and other outcomes between patients who had debridement (CL-Deb) and those who had observation (CL-noDeb) of unstable chondral lesions encountered during APM.
Patients who were ≥30 years old and undergoing APM were randomized to receive debridement (CL-Deb group; n = 98) or observation (CL-noDeb; n = 92) of unstable Outerbridge grade-II, III, or IV chondral lesions. Outcomes were evaluated preoperatively and at 8 to 12 days, 6 weeks, 3 months, 6 months, and 1 year postoperatively. Outcome measures included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee Injury and Osteoarthritis Outcome Score (KOOS), visual analog scale (VAS) pain score, Short Form-36 (SF-36) health survey, range of motion, quadriceps circumference, and effusion. The primary outcome was the WOMAC pain score at 1 year. T tests were used to examine group differences in outcomes, and the means and standard deviations are reported.
There were no significant differences between the groups with respect to any of the 1-year outcome scores. Compared with the CL-Deb group, the CL-noDeb group had improvement in the KOOS quality-of-life (p = 0.04) and SF-36 physical functioning scores (p = 0.01) as well as increased quadriceps circumference at 8 to 12 days (p = 0.02); had improvement in the pain score on the WOMAC (p = 0.02) and KOOS (p = 0.04) at 6 weeks; had improvement in SF-36 physical functioning scores at 3 months (p = 0.01); and had increased quadriceps circumference at 6 months (p = 0.02).
Outcomes for the CL-Deb and CL-noDeb groups did not differ at 1 year postoperatively. This suggests that there is no benefit to arthroscopic debridement of unstable chondral lesions encountered during APM, and it is recommended that these lesions be left in situ.
Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
关节镜下部分半月板切除术（APM）过程中观察到的不稳定软骨损伤是否需要治疗尚不清楚。我们比较了APM过程中遇到的不稳定软骨损伤患者，清创治疗组（CL-Deb）和观察等待组（CL-noDeb）在1年时膝关节疼痛及其他预后指标的差异。
年龄≥30岁且接受APM的患者被随机分为两组，分别接受对不稳定的外布里奇（Outerbridge）II级、III级或IV级软骨损伤的清创治疗（CL-Deb组，n = 98）或观察等待（CL-noDeb组，n = 92）。在术前、术后8至12天、6周、3个月、6个月和1年时评估预后情况。预后指标包括西安大略和麦克马斯特大学骨关节炎指数（WOMAC）、膝关节损伤和骨关节炎预后评分（KOOS）、视觉模拟量表（VAS）疼痛评分、简短健康调查问卷36项版（SF-36）、活动范围、股四头肌周长和积液情况。主要预后指标是1年时的WOMAC疼痛评分。采用t检验来检验两组预后指标的差异，并报告均值和标准差。
两组在任何1年的预后评分方面均无显著差异。与CL-Deb组相比，CL-noDeb组在KOOS生活质量评分（p = 0.04）和SF-36身体功能评分（p = 0.01）方面有所改善，且在术后8至12天时股四头肌周长增加（p = 0.02）；在术后6周时WOMAC疼痛评分（p = 0.02）和KOOS疼痛评分（p = 0.04）有所改善；在术后3个月时SF-36身体功能评分有所改善（p = 0.01）；在术后6个月时股四头肌周长增加（p = 0.02）。
CL-Deb组和CL-noDeb组在术后1年时的预后情况无差异。这表明对APM过程中遇到的不稳定软骨损伤进行关节镜下清创治疗并无益处，建议对这些损伤采取原位保留的处理方式。
治疗性I级。有关证据水平完整描述，请参见《作者须知》。
