Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.
Department of Musculoskeletal Radiology, Mayo Clinic, Rochester, Minnesota.
J Knee Surg. 2021 Jan;34(2):155-163. doi: 10.1055/s-0039-1693724. Epub 2019 Aug 7.
The meniscal ossicle is observed in clinical practice, yet there currently is limited information on its potential clinical significance. The purpose of this study was to assess the clinical presentation, imaging findings, and clinical treatment and outcomes of a series of patients identified as having a meniscal ossicle. An institutional database was reviewed to identify knees with a meniscal ossicle. Clinical presentation, magnetic resonance imaging (MRI), treatment, and outcomes were analyzed. Radiographs were graded using Kellgren-Lawrence (KL) scores. MRIs were reviewed for the presence and location of meniscal ossicles and additional knee pathology. Knee arthroplasty rates were recorded with the remaining patients contacted to obtain final International Knee Documentation Committee (IKDC) and Tegner's scores. Failure was defined as conversion to arthroplasty or failing IKDC score (< 75.4). Forty-five meniscal ossicles in 45 patients (26 males and 19 females) with a mean age of 51 years (standard deviation [SD] = 19.0) were included. Pain was the most common presenting symptom (89%). Forty-two patients (93%) had an associated meniscus root tear on MRI. Eighteen percent of patients that did not have an ossicle on initial imaging subsequently developed an ossicle. Mean KL grades progressed significantly from baseline of 1.84 (SD = 1.0) to 2.55 (SD = 0.93 < 0.01) on final follow-up. Thirty-nine percent of baseline radiographs showed KL grades of less than 2 compared with only 15% of follow-up radiographs ( = 0.04). Mean IKDC score obtained for patients ≤ 60 at an average follow-up of 3.1 years (SD = 3.2) was 65.2 (SD = 19.0). Eight out of 45 patients (18%) had progressed to total knee arthroplasty (TKA) by latest available follow-up. Sixty-two percent of patients met failure criteria at latest available follow-up. The meniscal ossicle is most commonly found in the posterior horn or root of the medial meniscus and is highly suggestive to be sequelae of a posterior root tear. Therefore, the presence of a meniscal ossicle should alert the orthopaedic surgeon to the high likelihood of the patient having a meniscus root tear. These patients have shown to have poor clinical outcomes and worsening arthritis.
半月板骨软骨块在临床实践中被观察到，但目前对于其潜在的临床意义的信息有限。本研究的目的是评估一组被诊断为半月板骨软骨块的患者的临床表现、影像学表现、临床治疗和结果。对一个机构数据库进行了回顾，以确定有半月板骨软骨块的膝关节。分析了临床表现、磁共振成像（MRI）、治疗和结果。使用 Kellgren-Lawrence（KL）评分对 X 线片进行分级。对 MRI 进行了评估，以确定半月板骨软骨块的存在和位置以及其他膝关节病变。记录膝关节置换率，并与其余患者联系以获得最终的国际膝关节文献委员会（IKDC）和 Tegner 评分。将失败定义为转为关节置换或 IKDC 评分<75.4。45 名患者（26 名男性和 19 名女性）共 45 个半月板骨软骨块，平均年龄为 51 岁（标准差[SD] = 19.0）。疼痛是最常见的症状（89%）。42 名患者（93%）在 MRI 上有半月板根部撕裂。18%的初始影像学检查无骨软骨块的患者随后出现了骨软骨块。KL 分级从基线的 1.84（SD = 1.0）显著进展到最终随访的 2.55（SD = 0.93， <0.01）。基线 X 线片有 39%的 KL 分级小于 2，而随访 X 线片只有 15%（ =0.04）。平均随访 3.1 年（SD = 3.2）时，≤60 岁患者的 IKDC 平均评分为 65.2（SD = 19.0）。在最新随访时，45 名患者中有 8 名（18%）进展为全膝关节置换术（TKA）。62%的患者在最新随访时达到了失败标准。半月板骨软骨块最常见于内侧半月板后角或根部，高度提示为后根撕裂的后遗症。因此，半月板骨软骨块的存在应该提醒骨科医生患者很可能有半月板根部撕裂。这些患者的临床结果较差，关节炎恶化。
