Arthroscopy and Joint Research Institute, Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea.
Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea.
Biomed Res Int. 2018 May 23;2018:5941057. doi: 10.1155/2018/5941057. eCollection 2018.
The purpose of this study was to compare preoperative variables and postoperative outcomes between flap tears with and without incarceration of inferiorly displaced fragments of medial meniscus and find distinct features of incarcerated flap tear of medial meniscus to improve preoperative diagnosis. 79 patients who underwent partial meniscectomy for flap tear of medial meniscus were classified into two groups: group U, usual flap tear without incarcerated fragment; group I, flap tear with incarcerated inferiorly displaced fragment. Patient characteristics and preoperative variables including duration of symptom aggravation were investigated. A comprehensive physical examination including joint line tenderness was performed. Magnetic resonance imaging (MRI) examination was carried out on all patients. Clinical assessments were performed with functional scores including visual analogue scale (VAS), and radiologic evaluation was conducted. Preoperative values and postoperative outcomes measured at the minimum follow-up duration of 2 years were compared between the groups. The groups did not differ significantly regarding postoperative outcomes by functional and radiological evaluations ( > 0.05). In making preoperative diagnosis, sensitivity of diagnosis based solely on MR images was significantly lower in group I (68.8%) than that in group U (90.5%) ( = 0.040). The following clinical features differed significantly between the groups: Patients in group I had higher scores in preoperative VAS (group U = 6.6; group I = 7.7) ( = 0.011) and shorter duration of symptom aggravation (group U = 13.8 weeks; group I = 3.9 weeks) ( < 0.001). Joint line tenderness was positive more distinctly in group I (100%) than in group U (74.6%). If displaced flap tear was properly resected, improved outcomes did not differ regardless of incarceration of flap tear. In diagnosing incarcerated inferiorly displaced flap tear, sensitivity of diagnosis based solely on MR images could be low. Distinguishing clinical findings would be helpful in obtaining a more appropriate diagnosis.
本研究旨在比较内侧半月板下移位瓣撕裂伴或不伴下嵌顿瓣撕裂的术前变量和术后结果，并找到内侧半月板嵌顿瓣撕裂的独特特征，以提高术前诊断。79 名因内侧半月板瓣撕裂而行部分半月板切除术的患者被分为两组：U 组，通常为无嵌顿瓣撕裂；I 组，瓣撕裂伴下移位瓣嵌顿。研究人员调查了患者特征和术前变量，包括症状加重的持续时间。对所有患者进行了全面的体格检查，包括关节线压痛。对所有患者进行了磁共振成像（MRI）检查。所有患者均进行了临床评估，包括视觉模拟评分（VAS）功能评分，以及影像学评估。比较两组患者的术前值和术后至少 2 年的随访结果。两组患者在功能和影像学评估的术后结果方面无显著差异（>0.05）。在术前诊断方面，仅基于 MRI 图像进行诊断的敏感性在 I 组（68.8%）明显低于 U 组（90.5%）（=0.040）。两组之间存在以下显著的临床差异：I 组患者术前 VAS 评分较高（U 组=6.6；I 组=7.7）（=0.011），症状加重的持续时间较短（U 组=13.8 周；I 组=3.9 周）（<0.001）。I 组的关节线压痛更为明显（100%），而 U 组为 74.6%。如果正确切除移位瓣，无论瓣撕裂是否嵌顿，改善的结果都没有差异。在诊断内侧半月板下嵌顿瓣撕裂时，仅基于 MRI 图像的诊断敏感性可能较低。鉴别临床发现有助于获得更合适的诊断。
