Ramsay Générale de Santé, Hôpital privé Jean Mermoz, Centre Orthopédique Santy, 24, Avenue Paul Santy, 69008, Lyon, France.
Mater Private Cork, City Gate, Mahon, Cork, Ireland.
Arch Orthop Trauma Surg. 2020 Nov;140(11):1649-1654. doi: 10.1007/s00402-020-03346-1. Epub 2020 Jan 28.
The failure rate of meniscal repair remains significant, especially for bucket-handle tears. This study aimed to evaluate the clinical outcomes, failure rate and risk factors for failure of bucket-handle medial meniscal tear repairs performed during ACL reconstruction.
A retrospective analysis of prospectively collected data was performed on a consecutive series of 96 ACL reconstructions with meniscal arthroscopic suture of a bucket-handle tear of the medial meniscus with a minimum 2 year follow-up. Preoperative and postoperative evaluation at last follow-up included objective IKDC rating, instrumented differential laxity and Tegner activity level. Functional outcome was evaluated with Lysholm score at last follow-up. Failure rate, survival curves and risk factor analysis using Cox proportional hazard ratio models were performed to analyze suture repair failure.
At IKDC rating, all patients were C or D preoperatively, whereas they where all A or B at last follow-up. Instrumented differential laxity improved from 6.77 mm (1.57) to 1.02 mm (1.15) mm at last follow-up (p = 1.9 E). The mean Tegner score before injury was 6.79 (± 1.47) and 6.11 (± 1.75) at last follow-up (p = 0.0011). Mean Lyholm score at last follow-up was 91.53 (± 11.6). The average entire cohort failure rate was 19% at final follow-up of 35.2 ± 9.8 months. Kaplan-Meier survival analysis demonstrated that the probability of the absence of failure decreased constantly over time. No significant difference in the objective IKDC, Lysholm or Tegner scores was observed between the failure group and the success group. Multivariate analysis revealed that younger patients and a procedure of ACL revision are more at risk for suture repair failure. In the majority of cases, the meniscal lesion observed at revision was equivalent or less extensive than the initial lesion.
Despite the fact that failure rate remains high for medial meniscus bucket-handle tears, suture repair of bucket-handle tears should be encouraged taking into account the long-term consequences of menisectomy.
半月板修复的失败率仍然很高，尤其是对于桶柄状撕裂。本研究旨在评估在 ACL 重建期间行内侧半月板桶柄状撕裂关节镜缝合的临床结果、失败率以及失败的风险因素。
对连续 96 例 ACL 重建患者的前瞻性数据进行回顾性分析，这些患者均接受了内侧半月板桶柄状撕裂的关节镜下缝合，且至少随访 2 年。末次随访时进行术前和术后评估，包括客观 IKDC 评分、仪器化的差度松弛度和 Tegner 活动水平。末次随访时采用 Lysholm 评分评估功能结果。使用 Cox 比例风险比模型进行失败率、生存曲线和风险因素分析，以分析缝合修复失败。
IKDC 评分显示，所有患者术前均为 C 或 D 级，而末次随访时均为 A 或 B 级。仪器化的差度松弛度从术前的 6.77mm（1.57）改善至末次随访时的 1.02mm（1.15）（p=1.9E）。受伤前的平均 Tegner 评分为 6.79（±1.47），末次随访时为 6.11（±1.75）（p=0.0011）。末次随访时平均 Lysholm 评分为 91.53（±11.6）。整个队列的平均终末随访失败率为 19%，随访时间为 35.2±9.8 个月。Kaplan-Meier 生存分析表明，无失败概率随时间的推移持续下降。失败组和成功组之间的客观 IKDC、Lysholm 或 Tegner 评分无显著差异。多变量分析显示，年轻患者和 ACL 翻修术式是缝合修复失败的更高风险因素。在大多数情况下，翻修时观察到的半月板病变与初始病变相当或更小。
尽管内侧半月板桶柄状撕裂的修复失败率仍然很高，但考虑到半月板切除术的长期后果，应鼓励对桶柄状撕裂进行缝合修复。
