经胫骨固定治疗内侧半月板后根部撕裂可减少中老年患者内侧半月板的后突和生理性移位。

Transtibial fixation for medial meniscus posterior root tear reduces posterior extrusion and physiological translation of the medial meniscus in middle-aged and elderly patients.

机构信息

Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan.

Department of Orthopaedic Surgery, Iwakuni Clinical Center, 1-1-1 Atagomachi, Iwakuni, Yamaguchi, 740-8510, Japan.

出版信息

Knee Surg Sports Traumatol Arthrosc. 2020 Nov;28(11):3416-3425. doi: 10.1007/s00167-019-05810-x. Epub 2019 Nov 28.

DOI:10.1007/s00167-019-05810-x

PMID:31781798

Abstract

PURPOSE

To investigate changes in meniscal extrusion during knee flexion before and after pullout fixation for medial meniscus posterior root tear (MMPRT) and determine whether these changes correlate with articular cartilage degeneration and short-term clinical outcomes.

METHODS

Twenty-two patients (mean age 58.4 ± 8.2 years) diagnosed with type II MMPRT underwent open magnetic resonance imaging preoperatively, 3 months after transtibial fixation and at 12 months after surgery, when second-look arthroscopy was also performed. The medial meniscus medial extrusion (MMME) and the medial meniscus posterior extrusion (MMPE) were measured at knee 10° and 90° flexion at which medial meniscus (MM) posterior translation was also calculated. Articular cartilage degeneration was assessed using International Cartilage Research Society grade at primary surgery and second-look arthroscopy. Clinical evaluations included Knee Injury and Osteoarthritis Outcome Score, International Knee Documentation Committee subjective knee evaluation form, Lysholm score, Tegner activity level scale, and pain visual analogue scale.

RESULTS

MMPE at 10° knee flexion was higher 12 months postoperatively than preoperatively (4.8 ± 1.5 vs. 3.5 ± 1.2, p = 0.01). MMPE at 90° knee flexion and MM posterior translation were smaller 12 months postoperatively than preoperatively (3.5 ± 1.1 vs. 4.6 ± 1.3, 7.2 ± 1.7 vs. 8.9 ± 2.0, p < 0.01). Articular cartilage degeneration of medial femoral condyle correlated with MMME in knee extension (r = 0.5, p = 0.04). All clinical scores significantly improved 12 months postoperatively. However, correlations of all clinical scores against decreased MMPE and increased MMME were not detected.

CONCLUSIONS

MMPRT transtibial fixation suppressed the progression of MMPE and cartilage degeneration and progressed MMME minimally in knee flexion position at 1 year. However, in the knee extension position, MMME progressed and correlated with cartilage degeneration of medial femoral condyle. MMPRT transtibial fixation contributes to the dynamic stability of the MM in the knee flexion position.

LEVEL OF EVIDENCE

IV.

摘要

目的

研究内侧半月板后根撕裂（MMPRT）经胫骨栓固定治疗前后膝关节屈曲时半月板外突的变化，并确定这些变化是否与关节软骨退变和短期临床结果相关。

方法

22 例（平均年龄 58.4±8.2 岁）经 MRI 证实为 II 型 MMPRT 的患者，术前、经胫骨栓固定后 3 个月及术后 12 个月行膝关节 10°和 90°屈伸位检查，同时行二次关节镜检查。测量膝关节 10°和 90°屈曲时的内侧半月板内侧外突（MMME）和内侧半月板后外突（MMPE），并计算内侧半月板后移。初次手术和二次关节镜检查时采用国际软骨修复协会（ICRS）分级评估关节软骨退变。临床评估包括膝关节损伤和骨关节炎评分（KOOS）、国际膝关节文献委员会主观膝关节评分（IKDC）、Lysholm 评分、Tegner 活动水平量表和疼痛视觉模拟量表（VAS）。

结果

术后 12 个月膝关节 10°屈曲时 MMPE 高于术前（4.8±1.5 比 3.5±1.2，p=0.01）。术后 12 个月膝关节 90°屈曲时 MMPE 和 MM 后移小于术前（3.5±1.1 比 4.6±1.3，7.2±1.7 比 8.9±2.0，p<0.01）。内侧股骨髁关节软骨退变与膝关节伸直时 MMME 相关（r=0.5，p=0.04）。所有临床评分术后 12 个月均显著改善。然而，并未发现所有临床评分与 MMPE 减少和 MMME 增加有相关性。