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外侧盘状半月板患者对侧膝关节的转归。

The Fate of the Contralateral Knee in Patients With a Lateral Discoid Meniscus.

机构信息

Department of Orthopaedic Surgery, Yonsei University College of Medicine, and Arthroscopy and Joint Research Institute, Yonsei University Health System, Seoul, Republic of Korea.

Department of Orthopaedic Surgery, Yonsei University College of Medicine, and Arthroscopy and Joint Research Institute, Yonsei University Health System, Seoul, Republic of Korea; Department of Orthopaedic Surgery, Yonsesarang Hospital, Seoul, Republic of Korea.

出版信息

Arthroscopy. 2019 Feb;35(2):500-506. doi: 10.1016/j.arthro.2018.07.045. Epub 2019 Jan 2.

Abstract

PURPOSE

To analyze the survivorship of the lateral meniscus (LM) in the contralateral knee after surgery for symptomatic torn discoid lateral meniscus (DLM) and to determine its associated factors.

METHODS

Two hundred ninety-six patients who underwent arthroscopic meniscectomy for torn symptomatic DLM were reviewed retrospectively. Patients were classified into subgroups based on demographic, clinical, and radiologic variables. The survivorship analysis of the LM on the contralateral knee was calculated using the Kaplan-Meier method, and comparison among the subgroups was conducted using the log-rank test. The predicted prognostic factors associated with survivorship were determined using Cox proportional hazard regression analysis.

RESULTS

Of the 296 patients, 51 (17%) had arthroscopic surgery in the contralateral knee during the study period. The group ≥40 years old had significantly worse survival than the group <40 (log-rank test, P < .001). In terms of radiologic variables, the group with Kellgren-Lawrence grade 3 or 4 had significantly poorer survivorship than that with grade 1 or 2 (log-rank test, P = .045). Age ≥40 years was associated with poorer survivorship (hazard ratio, 3.235; 95% confidence interval, 1.782-5.875; P < .001). Kellgren-Lawrence grades 3 and 4 in the contralateral knee were associated with poorer survival (hazard ratio, 2.071; 95% confidence interval, 1.061-4.043; P = .033). The cumulative survival rate at 10 years of the LM in the contralateral knee after surgery for symptomatic torn DLM was 81%.

CONCLUSIONS

Patients with a lateral discoid meniscus have a risk of a similar condition in the contralateral knee. Increased risks of symptomatology are associated with age and degenerative changes.

LEVEL OF EVIDENCE

Level IV, retrospective uncontrolled case series.

摘要

目的

分析因症状性盘状外侧半月板(DLM)撕裂而接受手术治疗后的对侧膝关节外侧半月板(LM)的存活率,并确定其相关因素。

方法

回顾性分析了 296 例因症状性撕裂的 DLM 而行关节镜下半月板切除术的患者。根据人口统计学、临床和影像学变量对患者进行亚组分类。使用 Kaplan-Meier 法计算对侧膝关节 LM 的存活率,并使用对数秩检验比较各亚组间的差异。使用 Cox 比例风险回归分析确定与存活率相关的预测预后因素。

结果

在 296 例患者中,51 例(17%)在研究期间对侧膝关节行关节镜手术。≥40 岁组的生存率明显低于<40 岁组(对数秩检验,P<0.001)。在影像学变量方面,Kellgren-Lawrence 分级 3 或 4 级组的生存率明显低于 1 或 2 级组(对数秩检验,P=0.045)。年龄≥40 岁与生存率较差相关(风险比,3.235;95%置信区间,1.782-5.875;P<0.001)。对侧膝关节 Kellgren-Lawrence 分级 3 级和 4 级与生存率较差相关(风险比,2.071;95%置信区间,1.061-4.043;P=0.033)。因症状性撕裂的 DLM 而行手术治疗后的对侧膝关节 LM 10 年累积生存率为 81%。

结论

外侧盘状半月板患者对侧膝关节存在类似病症的风险。症状出现的风险与年龄和退行性变化相关。

证据等级

IV 级,回顾性非对照病例系列研究。

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