Goebel L, Reinhard J, Madry H
Lehrstuhl für Experimentelle Orthopädie und Arthroseforschung, Zentrum für Experimentelle Orthopädie, Universität des Saarlandes, Gebäude 37, Kirrbergerstraße 100, 66421, Homburg/Saar, Deutschland.
Klinik für Orthopädie und Orthopädische Chirurgie, Universitätsklinikum des Saarlandes, Gebäude 37-38, Kirrbergerstraße 100, 66421, Homburg/Saar, Deutschland.
Orthopade. 2017 Oct;46(10):822-830. doi: 10.1007/s00132-017-3462-y.
A close relationship between meniscal damage and articular cartilage exist. Likewise, (partial) meniscectomy may lead to the development of osteoarthritis (OA).
With a special emphasis on therapeutic consequences for orthopaedic surgeons, the structural and functional relationship between meniscal tears/extrusion and cartilage loss, and/or the effect of meniscectomy or meniscal repair on the development of OA, are emphasized.
A selective literature review with implementation of own research findings.
The close topographical and functional interplay between the menisci and the tibiofemoral cartilage is the basis for the clinically important relationship between meniscal damage and cartilage degeneration. In particular, due to its close connection to tibiofemoral OA, a degenerative meniscal lesion represents a pre-osteoarthritic condition. Meniscus extrusion is also often associated with tibiofemoral OA. Even large cartilage defects can cause meniscus lesions. Partial meniscectomy is strongly associated with the incidence and risk of progression of OA. Clinical results are particularly problematic after partial resection of the lateral meniscus. Although the use of arthroscopic partial resection for degenerative meniscal lesions has been controversially discussed, no long-term studies are available. A large number of studies emphasize the medium-term value of meniscus reconstruction compared to partial meniscus resection. Combined meniscus and cartilage damage are complex cases, and the value of a simultaneous therapy remains unclear.
Preserving the meniscus is the first step towards cartilage repair. Randomized and controlled studies will provide better information on the long-term outcomes of meniscal resection and repair with regard to OA development.
半月板损伤与关节软骨之间存在密切关系。同样，（部分）半月板切除术可能会导致骨关节炎（OA）的发展。
特别强调对骨科医生的治疗后果，着重阐述半月板撕裂/挤出与软骨损失之间的结构和功能关系，以及半月板切除术或半月板修复对OA发展的影响。
通过纳入自身研究结果进行选择性文献综述。
半月板与胫股关节软骨之间紧密的局部解剖和功能相互作用，是半月板损伤与软骨退变之间临床重要关系的基础。特别是，由于其与胫股关节OA的密切联系，退行性半月板损伤代表了骨关节炎前期状态。半月板挤出也常与胫股关节OA相关。即使是大的软骨缺损也会导致半月板损伤。部分半月板切除术与OA的发生率和进展风险密切相关。外侧半月板部分切除后的临床结果尤其成问题。尽管对于退行性半月板损伤采用关节镜下部分切除术一直存在争议性讨论，但尚无长期研究。大量研究强调与部分半月板切除术相比，半月板重建的中期价值。半月板和软骨联合损伤是复杂病例，同时治疗的价值仍不明确。
保留半月板是软骨修复的第一步。随机对照研究将为半月板切除和修复在OA发展方面的长期结果提供更好的信息。
