Feucht M J, Izadpanah K, Lacheta L, Südkamp N P, Imhoff A B, Forkel P
Department of Orthopaedic Sports Medicine, Technical University Munich, Ismaninger Straße 22, 81675, Munich, Germany.
Clinic for Orthopaedic and Trauma Surgery, University Medical Center Freiburg, Freiburg, Germany.
Oper Orthop Traumatol. 2019 Jun;31(3):248-260. doi: 10.1007/s00064-018-0574-4. Epub 2018 Oct 26.
Anatomic repair of the torn meniscal root using transosseous sutures through the proximal tibia.
Nontraumatic meniscal root tears without severe degenerative changes (Kellgren-Lawrence grade ≤ 2), good quality meniscal tissue, traumatic root tears with or without concomitant anterior cruciate ligament tears or multiligament injuries.
Uncorrected varus or valgus malalignment (>3°), osteoarthritis Kellgren-Lawrence grades III and IV, and diffuse articular cartilage changes International Cartilage Regeneration and Joint Preservation Society (ICRS) grades III and IV of the effected compartment, noncompliance.
Root tear confirmed by probing; location for the planned root refixation on the tibial plateau is identified. A tibial socket or full transtibial tunnel created with an aiming drill guide. Using a self-retrieving suture passing device or a curved suture passer, the torn meniscus root sutured with no. 0 non-absorbable braided suture. Meniscal sutures passed through the tibial tunnel and the meniscus root reduced into the socket or tunnel by tensioning the free ends of the sutures, followed by fixation on the tibial cortex.
FOLLOW-UP: Toe touch weight-bearing for 6 weeks, restricted range of motion (0-60° of flexion) for 6 weeks, no axial loading at flexion angles >90° until 6 months postoperatively.
For medial root tears, pullout repair significantly improves functional outcome scores and seems to prevent the progression of osteoarthritis in the short-term. Complete healing observed in only 60% of patients. Negative prognostic factors: varus malalignment > 5°, cartilage degeneration Outerbridge grade III and IV, and older age. Outcomes after lateral root repair are encouraging with apparent prevention of progression of osteoarthritis.
通过胫骨近端采用经骨缝线对撕裂的半月板根部进行解剖修复。
无严重退变改变（凯尔格伦-劳伦斯分级≤2级）的非创伤性半月板根部撕裂、半月板组织质量良好、伴有或不伴有前交叉韧带撕裂或多韧带损伤的创伤性根部撕裂。
未矫正的内翻或外翻畸形（>3°）、凯尔格伦-劳伦斯III级和IV级骨关节炎、患侧间室国际软骨修复与关节保护学会（ICRS）III级和IV级的弥漫性关节软骨改变、不配合治疗。
通过探查确认根部撕裂；确定胫骨平台上计划进行根部重新固定的位置。使用瞄准钻导向器创建一个胫骨槽或全胫骨隧道。使用自取回缝线穿过装置或弯形缝线穿引器，用0号不可吸收编织缝线缝合撕裂的半月板根部。半月板缝线穿过胫骨隧道，通过拉紧缝线的自由端将半月板根部复位到槽或隧道内，随后固定在胫骨皮质上。
术后6周脚尖触地负重，6周内活动范围受限（屈曲0-60°），术后6个月内屈曲角度>90°时无轴向负荷。
对于内侧根部撕裂，拔出修复显著改善功能结果评分，并且在短期内似乎可预防骨关节炎进展。仅60%的患者观察到完全愈合。负面预后因素：内翻畸形>5°、软骨退变Outerbridge III级和IV级以及年龄较大。外侧根部修复后的结果令人鼓舞，明显预防了骨关节炎进展。
