Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
Knee Surg Sports Traumatol Arthrosc. 2020 Nov;28(11):3497-3503. doi: 10.1007/s00167-019-05634-9. Epub 2019 Jul 22.
This study aimed to investigate the long-term outcomes of arthroscopic partial meniscectomy for medial meniscus tear (with intact posterior root) and to analyze the risk factors for treatment failure.
The records of 165 patients who underwent partial meniscectomy for medial meniscus tear with intact posterior root with a minimum 5-year follow-up were included. Modified Lysholm score and radiologic outcomes were compared between preoperative and latest follow-up periods. The cumulative Outerbridge grade of the medial compartment was defined as follows: 0-4, low chondral wear; 5-6, intermediate wear; or 7-8, high wear. Kaplan-Meier survival and Cox hazard regression analyses were performed to assess the survivorship after partial meniscectomy. Conversion to total knee replacement arthroplasty, high tibial osteotomy or a Lysholm score of < 65 points indicated treatment failure.
Mean Lysholm score improved from 66.3 ± 14.2 preoperatively to 81.8 ± 17.9 at the latest follow-up (p = 0.001). The postoperative 10-year survival rate of the low chondral wear group [97% (95% confidence interval (CI) 141.7-152.6 months)] was higher than that of the intermediate [83.1% (95% CI 129.6-147.9 months)] and high wear groups [76.1% (95% CI 115.2-135.0 months)]. A 1 mm joint space width narrowing led to a 37.7% increase in the failure rate [B = - 0.473; hazard ratio, 0.623 (95% CI 0.423-0.917); p = 0.016]. The high chondral wear group showed a higher failure rate compared to the low wear group [B = 1.870; hazard ratio, 6.488 (95% CI 0.853-49.333); p = 0.041].
Partial meniscectomy offers pain relief and functional improvement for medial meniscus tear with intact posterior root. Preoperative joint space narrowing and higher chondral wear at surgery were significant risk factors of treatment failure. Partial meniscectomy should be considered as an effective treatment for irreparable medial meniscus tear with intact posterior root without joint space narrowing and chondral wear.
Case series, Level IV.
本研究旨在探讨关节镜下内侧半月板撕裂（后根完整）部分切除术的长期疗效，并分析治疗失败的风险因素。
纳入了 165 例接受内侧半月板撕裂后根完整的部分切除术患者，随访时间至少 5 年。比较术前和末次随访时的改良 Lysholm 评分和影像学结果。内侧间室的改良 Outerbridge 分级定义如下：0-4 级，低软骨磨损；5-6 级，中度磨损；或 7-8 级，高磨损。采用 Kaplan-Meier 生存分析和 Cox 风险回归分析评估部分切除术的生存率。全膝关节置换术、胫骨高位截骨术或 Lysholm 评分<65 分提示治疗失败。
平均 Lysholm 评分从术前的 66.3±14.2 分提高到末次随访时的 81.8±17.9 分（p=0.001）。低软骨磨损组[97%（95%可信区间 141.7-152.6 个月）]的术后 10 年生存率高于中磨损组[83.1%（95%可信区间 129.6-147.9 个月）]和高磨损组[76.1%（95%可信区间 115.2-135.0 个月）]。关节间隙狭窄 1mm 会使失败率增加 37.7%[B=-0.473；风险比，0.623（95%可信区间 0.423-0.917）；p=0.016]。与低磨损组相比，高软骨磨损组的失败率更高[B=1.870；风险比，6.488（95%可信区间 0.853-49.333）；p=0.041]。
关节镜下内侧半月板撕裂（后根完整）部分切除术可缓解疼痛，改善功能。术前关节间隙狭窄和术中软骨磨损较高是治疗失败的显著危险因素。对于没有关节间隙狭窄和软骨磨损的不可修复性内侧半月板撕裂，应考虑行部分切除术作为有效治疗方法。
病例系列，IV 级。
