Laurendon L, Neri T, Farizon F, Philippot R
Service d'orthopédie et traumatologie, CHU de St-Étienne, avenue Albert-Raimond, 42000 Saint-Étienne, France.
Service d'orthopédie et traumatologie, CHU de St-Étienne, avenue Albert-Raimond, 42000 Saint-Étienne, France; Laboratoire interuniversitaire de biologie de la motricité (LIBM), EA 7424, université Claude-Bernard-Lyon 1, université Jean-Monnet-Saint-Étienne, 42000 Saint-Étienne, France.
Orthop Traumatol Surg Res. 2017 Nov;103(7):1017-1020. doi: 10.1016/j.otsr.2017.05.025. Epub 2017 Aug 2.
Repair is indicated for tears in non-degenerative menisci. The literature reports a 15% failure rate for all-inside repair. The aim of the present study was to determine prognostic factors for failure of all-inside meniscal repair. The study hypothesis was that epidemiological, clinical and surgical factors affect success.
A retrospective study included 87 meniscal repair procedures, with or without anterior cruciate ligament (ACL) tear. Lesions were located in red-red or red-white zones. After freshening, repair comprised an all-inside arthroscopic technique using the FasT-Fix system (Smith & Nephew), with (70.1%) or without ligament reconstruction; all ACL tears were reconstructed. Preoperative data comprised: age, gender, smoking status, sports activity, trauma-to-surgery time, body mass index (BMI), frontal morphotype, and IKDC score. Intra- and postoperative data comprised: meniscal lesion characteristics, location, number of sutures, type of ACL reconstruction, presence of chondropathy, authorized postoperative ranges of motion, and IKDC score. Failure was defined by secondary meniscectomy.
At 31 months' follow-up, there were 13 failures (15%). Mean postoperative IKDC score was 88.19 (range: 64.37-98.95). Bucket-handle lesion (P=0.006) and BMI>25 (P=0.014) emerged as significant factors of poor prognosis.
The present failure rate matched those reported in the literature. The more extensive the lesion, the higher the risk of failure. High BMI incurs mechanical stresses that increase the risk of failure.
IV, retrospective cohort study.
非退行性半月板撕裂需进行修复。文献报道全内修复的失败率为15%。本研究的目的是确定全内半月板修复失败的预后因素。研究假设为流行病学、临床和手术因素会影响修复成功率。
一项回顾性研究纳入了87例半月板修复手术，这些手术患者伴有或不伴有前交叉韧带（ACL）撕裂。损伤位于红-红区或红-白区。清创后，采用FasT-Fix系统（施乐辉公司）通过全内关节镜技术进行修复，70.1%的患者同时或不同时进行韧带重建；所有ACL撕裂均进行了重建。术前数据包括：年龄、性别、吸烟状况、体育活动、受伤至手术时间、体重指数（BMI）、额面形态类型和国际膝关节文献委员会（IKDC）评分。术中和术后数据包括：半月板损伤特征、位置、缝线数量、ACL重建类型、软骨病的存在情况、术后允许的活动范围以及IKDC评分。失败定义为二次半月板切除术。
在31个月的随访中，有13例失败（15%）。术后平均IKDC评分为88.19（范围：64.37 - 98.95）。桶柄状损伤（P = 0.006）和BMI>25（P = 0.014）是预后不良的显著因素。
目前的失败率与文献报道相符。损伤范围越广泛，失败风险越高。高BMI会产生机械应力，增加失败风险。
IV级，回顾性队列研究。
