在退行性内侧半月板后根部撕裂的患者中，与中立位相比，内侧半月板部分切除术会导致放射学骨关节炎的进展更快：至少 5 年的随访结果。
Progression of radiographic osteoarthritis after partial meniscectomy in degenerative medial meniscal posterior root tears was greater in varus- than in neutral-aligned knees: a minimum 5-year follow-up.
机构信息
Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
出版信息
Knee Surg Sports Traumatol Arthrosc. 2020 Nov;28(11):3443-3449. doi: 10.1007/s00167-020-05905-w. Epub 2020 Feb 17.
PURPOSE
To perform a radiographic assessment of osteoarthritis, progression after partial meniscectomy (PM) in degenerative medial meniscus posterior root tears (MMPRTs) in relation to preoperative mechanical axis (MA). The hypothesis is that neutral-aligned knees with degenerative MMPRTs have better radiographic outcomes than those of varus-aligned knees after arthroscopic PM.
METHODS
Records of 114 patients with degenerative MMPRTs and Kellgren-Lawrence (KL) grade ≤ 2 osteoarthritis, who underwent PM, had preoperative weight-bearing hip-to-ankle radiographs from 2004 to 2014, and were followed-up for at least 5 years were reviewed retrospectively. The mean follow-up period was 8.3 ± 2.8 years. Preoperative MA values were used to classify the patients into either a Neutral (N valgus 3° to varus 3°; n = 60) or Varus-aligned group (V varus > 3°; n = 54). Joint space width (JSW; mm) and KL grade (0/1/2/3/4) were measured preoperatively and finally on weight-bearing 45° flexion posteroanterior and anteroposterior radiographs, respectively.
RESULTS
Preoperative JSW and KL grade did not differ significantly between the groups (N vs V; JSW 3.64 ± 0.83 vs 3.44 ± 0.81, P = 0.201; KL grade, 2/31/27/0/0 vs 0/22/32/0/0, P = 0.162); however, the final JSW and KL grade differed significantly between the groups (N vs V; JSW 3.03 ± 0.78 vs 2.07 ± 0.87; KL grade, 0/21/23/13/3 vs 0/10/26/21/6, both P < 0.001). The N group showed significantly less KL progression compared with the V group (N vs V; progression/no progression, 27/33 vs 42/12, P = 0.001).
CONCLUSION
The progression of radiographic osteoarthritis after PM for degenerative MMPRTs was greater in varus-aligned knees than in neutral-aligned knees. PM should be considered cautiously in patients with varus-aligned knees.
LEVEL OF EVIDENCE
Retrospective comparative study, Level III.
目的
针对退行性后内侧半月板后根撕裂（MMPRTs）患者，在术前机械轴（MA）的基础上，对半月板部分切除术（PM）后骨关节炎的放射学进展进行评估。假设对于伴有退行性 MMPRTs 的中立位膝关节，其放射学结果要好于内侧对线不良（VAR）的膝关节。
方法
回顾性分析了 2004 年至 2014 年期间行 PM 治疗并伴有退行性 MMPRTs 和 Kellgren-Lawrence（KL）分级≤2 级骨关节炎的 114 例患者的病历。所有患者均行术前负重位髋关节-踝关节 X 线检查，并至少随访 5 年。平均随访时间为 8.3±2.8 年。使用术前 MA 值将患者分为中立组（N，外翻 3°至内翻 3°；n=60）或内翻组（V，内翻>3°；n=54）。术前和最后一次随访时，分别在负重 45°屈曲前后位和前后位 X 线片上测量关节间隙宽度（JSW；mm）和 KL 分级（0/1/2/3/4）。
结果
两组患者术前 JSW 和 KL 分级无显著差异（N 组 vs V 组；JSW 3.64±0.83 vs 3.44±0.81，P=0.201；KL 分级，2/31/27/0/0 vs 0/22/32/0/0，P=0.162）；然而，最终 JSW 和 KL 分级有显著差异（N 组 vs V 组；JSW 3.03±0.78 vs 2.07±0.87；KL 分级，0/21/23/13/3 vs 0/10/26/21/6，均 P<0.001）。与 V 组相比，N 组 KL 分级进展显著更少（N 组 vs V 组；进展/无进展，27/33 vs 42/12，P=0.001）。
结论
退行性 MMPRTs 患者 PM 后放射学骨关节炎的进展在 VAR 组较中立位组更为显著。对于 VAR 组的患者，应慎重考虑 PM。
证据水平
回顾性对比研究，III 级。
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