Service d'orthopédie C, CHRU de Lille, hôpital Salengro, place de Verdun, 59037 Lille cedex, France; Université de Lille, Hauts de France, 59000 Lille, France.
Service d'orthopédie D, CHRU de Lille, hôpital Salengro, place de Verdun, 59037 Lille cedex, France; Université de Lille, Hauts de France, 59000 Lille, France.
Orthop Traumatol Surg Res. 2018 Sep;104(5):707-711. doi: 10.1016/j.otsr.2018.05.007. Epub 2018 Jun 19.
Arthroscopic meniscectomy and medial meniscal repair are frequent procedures, liable to be complicated by iatrogenic cartilage lesions, especially in tight knee. Medial collateral ligament pie-crusting was developed to counter this, but, although the technique is employed, its impact on medial laxity has not been precisely determined. We therefore conducted a prospective observational study to compare radiographic laxity preoperatively versus 6 weeks following pie-crusting.
Medial collateral ligament pie-crusting alters radiographic laxity at 6 weeks.
Between December 2015 and February 2017, 40 patients (33 male, 7 female) underwent surgery with pie-crusting for isolated medial meniscal lesion. Mean age was 39 years (range, 20-54 years). Meniscectomy was performed in 33 cases (82.5%) and repair in 7 (17.5%). Pie-crusting used an intramuscular needle under arthroscopic control, adjacent to the medial meniscus at the posterior two-thirds junction of the compartment, until opening was deemed satisfactory. Laxity was compared on preoperative versus 6 weeks stress valgus views (Telos ™), by 2 independent observers, on 2 measurements: opening angle, and medial tibiofemoral joint space height. Each measurement was taken twice at a 2-week interval by each observer.
Inter- and intra-observer concordance was excellent on both measurements: intraclass correlation coefficient was 0.82 (95% CI, 0.73-0.89) and 0.91 (95% CI, 0.86-0.94) pre- and post-operatively for opening angle, and 0.87 (95% CI, 0.79-0.92) and 0.88 (95% CI, 0.82-0.92) for joint space height. Tibiofemoral joint space opening was significantly greater at 6 weeks on both measurements: 0.9±1° [range, -1° to 4°] (p<0.0001) and 1.1±1mm [range, -0.6 to 3.2mm] (p<0.0001).
Medial collateral ligament pie-crusting led to a moderate but significant increase in medial laxity at 6 weeks. A longer-term study is needed to assess progression.
IV, prospective study without control group.
关节镜下半月板切除术和内侧半月板修复是常见的手术，容易发生医源性软骨损伤，尤其是在膝关节紧张的情况下。内侧副韧带 Pie-crusting 技术被开发出来以应对这种情况，但尽管该技术已经被采用，但它对内侧松弛的影响尚未被精确确定。因此，我们进行了一项前瞻性观察研究，比较了 Pie-crusting 术前和术后 6 周的放射松弛度。
内侧副韧带 Pie-crusting 会改变 6 周时的放射松弛度。
2015 年 12 月至 2017 年 2 月，40 例患者（33 例男性，7 例女性）因孤立性内侧半月板病变接受 Pie-crusting 手术。平均年龄 39 岁（范围，20-54 岁）。33 例（82.5%）行半月板切除术，7 例（17.5%）行修复术。Pie-crusting 使用关节镜下控制的肌内针，在关节腔后三分之二交界处的内侧半月板旁进行，直到认为开口满意为止。通过 2 位独立观察者，在术前和术后 6 周的应力外翻位（Telos ™）上比较松弛度，通过 2 个测量值进行比较：开口角度和内侧胫骨股骨关节间隙高度。每位观察者在 2 周的间隔内进行了两次测量。
两种测量值的观察者间和观察者内一致性均极好：术前和术后的开口角度的组内相关系数分别为 0.82（95%CI，0.73-0.89）和 0.91（95%CI，0.86-0.94），关节间隙高度的组内相关系数分别为 0.87（95%CI，0.79-0.92）和 0.88（95%CI，0.82-0.92）。在两种测量中，术后 6 周时胫骨股骨关节间隙开口均显著增大：0.9±1°[范围，-1°至 4°]（p<0.0001）和 1.1±1mm[范围，-0.6 至 3.2mm]（p<0.0001）。
内侧副韧带 Pie-crusting 在术后 6 周时导致了中等但显著的内侧松弛度增加。需要进行更长期的研究来评估进展情况。
IV，无对照组的前瞻性研究。
