Department of Orthopedic Surgery, University Medical Centre Ljubljana, Zaloška ulica 9, 1000, Ljubljana, Slovenia.
Chair of Orthopedics, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia.
Knee Surg Sports Traumatol Arthrosc. 2019 Jun;27(6):1817-1824. doi: 10.1007/s00167-019-05424-3. Epub 2019 Mar 11.
To provide a current review on the evidence for management of the symptomatic meniscus-deficient knee.
A literature review was performed detailing the natural history and origin of symptoms in a meniscus-deficient knee, in addition to strategies for non-surgical management, meniscus scaffolds, meniscus allograft transplantation (MAT), isolated cartilage repair, unloading osteotomies, meniscus prosthesis, and joint replacements which were revealed as treatment possibilities.
Meniscus deficiency was recognized to lead to an early onset knee osteoarthritis (OA). A subset of patients develop post-meniscectomy syndrome: dull and nagging pain after a short pain-free interval subsequently to meniscectomy, which can be accompanied by transient effusions. Evidence for non-surgical management of post-meniscectomy knee pain is lacking. Two available meniscus scaffolds, indicated for symptomatic segmental meniscus deficiency, show pain relief at mid-term follow-up, and effect on joint preservation is unclear. MAT represents a durable solution for sub/total meniscus deficiency (80% survival at 10 years), but it is still considered a temporary solution for post-meniscectomy pain. MAT may also reduce the progression of OA. Isolated cartilage repair without a meniscus reconstruction is commonly performed, but better results were reported with preserved or reconstructed menisci. Osteotomies are used in the combination of misaligned knee and meniscus reconstruction or as pain solution for irreversible unilateral knee structural changes following a meniscectomy. Polycarbonate-urethane medial meniscus prosthesis is currently undergoing clinical trial. Joint replacements should be limited to later stages of post-meniscectomy OA.
Post-meniscectomy pain syndrome and post-meniscectomy knee OA are common findings after meniscus resection. Short-term pain relief is provided by non-surgical management, mid-term pain relief by meniscus scaffolds, and long-term relief by MAT, though each has differing indications. In later stages, osteotomies and joint replacements are indicated.
IV.
提供关于膝关节半月板缺失的症状管理的证据综述。
详细回顾半月板缺失膝关节的自然病史和症状起源，以及非手术治疗、半月板支架、半月板同种异体移植（MAT）、孤立软骨修复、减压截骨术、半月板假体和关节置换等治疗方法。
半月板缺失被认为会导致早期膝关节骨关节炎（OA）。一部分患者会出现半月板切除术后综合征：半月板切除术后短暂无痛期后出现钝痛和持续疼痛，可能伴有短暂性积液。缺乏非手术治疗半月板切除术后膝关节疼痛的证据。两种现有的半月板支架，适用于症状性节段性半月板缺失，在中期随访时显示出疼痛缓解，但对关节保护的影响尚不清楚。MAT 代表了亚全半月板缺失的持久解决方案（10 年存活率为 80%），但它仍被认为是半月板切除术后疼痛的临时解决方案。MAT 还可能减缓 OA 的进展。孤立的软骨修复而没有半月板重建通常进行，但保留或重建的半月板会产生更好的结果。对于未对齐的膝关节和半月板重建，或者对于半月板切除术后不可逆的单侧膝关节结构变化引起的疼痛，截骨术是一种有效的解决方案。聚碳酸酯-聚氨酯内侧半月板假体目前正在进行临床试验。关节置换应限于半月板切除术后 OA 的晚期。
半月板切除术后，常见的发现是半月板切除术后疼痛综合征和半月板切除术后膝关节 OA。非手术治疗可提供短期疼痛缓解，半月板支架可提供中期疼痛缓解，MAT 可提供长期缓解，但每种方法的适应证不同。在晚期，截骨术和关节置换术是指征。
IV 级。
