半月板修复后使用全内缝合装置后囊肿形成的发生率、发展和相关因素。
Prevalence, development, and factors associated with cyst formation after meniscal repair with the all-inside suture device.
机构信息
Department of Orthopaedic Surgery, Osaka City Juso Hospital, 2-12-27 Nonaka-kita, Yodogawa-ku, Osaka-shi, Osaka-fu, 532-0034, Japan.
Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka-shi, Osaka-fu, 545-8585, Japan.
出版信息
Arch Orthop Trauma Surg. 2019 Sep;139(9):1261-1268. doi: 10.1007/s00402-019-03176-w. Epub 2019 Apr 9.
PURPOSE
To investigate the prevalence of cyst formation after using all-inside meniscal repair device and analysed the risk factors associated with it.
METHODS
Between August 2008 and September 2013, 51 menisci of 46 patients were included in the study, 46 menisci of which had concomitant anterior cruciate ligament (ACL) ruptures and had an ACL reconstruction. Magnetic resonance imaging (MRI) of the knee was performed at 3, 6, 12 and 24 months after meniscal surgery. The MRIs were assessed to detect the development of cysts encasing the suture anchors and to evaluate meniscal healing. Statistical analysis was performed using multiple regression analysis.
RESULTS
Out of the 51 menisci examined, MRI revealed cysts in 15 menisci. Cysts were detected in 3 menisci at 6 months, in 9 menisci at 12 months, and in 3 menisci at 24 months after surgery. Only 3 patients (6.5%) were symptomatic, and cystectomy was performed in 2 of these patients and arthroscopic debridement in the other. Compared with using both the suture device and an inside-out suture repair, using the suture device alone was more likely to be associated with cyst development [odds ratio (OR), 12.04]. The medial meniscus was also significantly more likely to develop a cyst compared with the lateral meniscus (OR, 12.48). There was an increased outcome for the number of device use (P = 0.033). Though it was not statistically significant, the patients with anterior knee laxity (side-to-side difference > 3 mm using a knee arthrometer) were more likely to develop cysts than those without anterior knee laxity (P = 0.06). There were no significant differences between the remaining variables.
CONCLUSIONS
The prevalence of cyst formation around the suture implant was 29%, but most cases were not symptomatic. Significant risk factors for cyst formation included the use of a suture device alone, and a location in the medial meniscus.
LEVEL OF EVIDENCE
III.
目的
研究全内半月板修复装置使用后囊肿形成的发生率，并分析其相关的危险因素。
方法
2008 年 8 月至 2013 年 9 月，本研究纳入了 46 名患者的 51 个半月板，其中 46 个半月板合并前交叉韧带（ACL）撕裂，并进行了 ACL 重建。半月板手术后 3、6、12 和 24 个月进行膝关节磁共振成像（MRI）。MRI 评估检测缝合锚钉周围包裹囊肿的发展情况，并评估半月板愈合情况。采用多元回归分析进行统计学分析。
结果
在 51 个半月板中，MRI 显示 15 个半月板有囊肿。术后 6 个月时，3 个半月板出现囊肿，12 个月时，9 个半月板出现囊肿，24 个月时，3 个半月板出现囊肿。只有 3 名患者（6.5%）有症状，其中 2 名患者进行了囊肿切除术，1 名患者进行了关节镜下清创术。与同时使用缝合装置和经内到外缝合修复相比，单独使用缝合装置更容易发生囊肿形成[比值比（OR），12.04]。与外侧半月板相比，内侧半月板发生囊肿的可能性也显著更高（OR，12.48）。装置使用数量的增加与结果相关（P = 0.033）。尽管没有统计学意义，但与没有前膝松弛（膝关节测径仪测量的侧-侧差值>3 毫米）的患者相比，前膝松弛的患者更有可能发生囊肿（P = 0.06）。其余变量之间无显著差异。
结论
缝合植入物周围囊肿形成的发生率为 29%，但大多数病例无症状。囊肿形成的显著危险因素包括单独使用缝合装置以及内侧半月板的位置。
证据等级
III 级。
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