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一种使用两针简单缝合的修复技术可减少内侧半月板后根撕裂拉出修复术后的短期内侧半月板挤压。

A repair technique using two simple stitches reduces the short-term postoperative medial meniscus extrusion after pullout repair for medial meniscus posterior root tear.

作者信息

Hiranaka Takaaki, Furumatsu Takayuki, Masuda Shin, Okazaki Yoshiki, Okazaki Yuki, Kodama Yuya, Kamatsuki Yusuke, Kajiki Yuya, Zhang Ximing, Ozaki Toshifumi

机构信息

Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan.

出版信息

Eur J Orthop Surg Traumatol. 2020 Jul;30(5):901-908. doi: 10.1007/s00590-020-02647-w. Epub 2020 Mar 10.

DOI:10.1007/s00590-020-02647-w
PMID:32157399
Abstract

BACKGROUND

Two types of repair techniques, FasT-Fix modified Mason-Allen (F-MMA) and two simple stitches (TSS), for the treatment of a medial meniscus posterior root tear (MMPRT) were previously reported. However, whether these techniques could prevent postoperative medial meniscus extrusion (MME) progression is unknown. This study investigated and compared postoperative MME of the two repair techniques.

METHODS

Forty-seven knees that had undergone pullout repair for MMPRT were retrospectively reviewed. These knees were divided into two groups as follows: In 26 knees, MMPRT was treated using the F-MMA technique and fixed with the knee flexed at 45° and 20 N of tension [F-MMA (45°-20 N) group], and in 21 knees, MMPRT was treated using the TSS technique and fixed with the knee flexed at 20° and 30 N of tension [TSS (20°-30 N) group]. The medial meniscus body width (MMBW), absolute MME (aMME), and relative MME (rMME = absolute MME/MMBW) were measured and compared using magnetic resonance imaging 3 months postoperatively. The Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales for clinical outcomes were compared between the two groups at 6 months postoperatively.

RESULTS

At 3 months postoperatively, the aMME and rMME significantly decreased in the TSS (20°-30 N) compared to the F-MMA (45°-20 N) group. The TSS (20°-30 N) group had better KOOS subscale scores than the F-MMA (45°-20 N) group at 6 months postoperatively.

CONCLUSIONS

The TSS technique with appropriate tibial fixation can decrease MME soon after surgery. This may prevent osteoarthritis progression and improve clinical outcomes.

摘要

背景

先前报道了两种用于治疗内侧半月板后根撕裂(MMPRT)的修复技术,即改良的FasT-Fix Mason-Allen(F-MMA)和两种简单缝线(TSS)。然而,这些技术能否预防术后内侧半月板挤出(MME)进展尚不清楚。本研究调查并比较了两种修复技术的术后MME情况。

方法

回顾性分析47例行MMPRT拉出修复术的膝关节。这些膝关节分为两组:26例膝关节采用F-MMA技术治疗,在膝关节屈曲45°、张力20 N的情况下固定[F-MMA(45°-20 N)组];21例膝关节采用TSS技术治疗,在膝关节屈曲20°、张力30 N的情况下固定[TSS(20°-30 N)组]。术后3个月使用磁共振成像测量并比较内侧半月板体部宽度(MMBW)、绝对MME(aMME)和相对MME(rMME =绝对MME/MMBW)。术后6个月比较两组临床结果的膝关节损伤和骨关节炎疗效评分(KOOS)子量表。

结果

术后3个月,与F-MMA(45°-20 N)组相比,TSS(20°-30 N)组的aMME和rMME显著降低。术后6个月,TSS(20°-30 N)组的KOOS子量表评分优于F-MMA((45°-20 N)组。

结论

采用适当胫骨固定的TSS技术可在术后早期减少MME。这可能预防骨关节炎进展并改善临床结果。

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本文引用的文献

1
Time-Dependent Increase in Medial Meniscus Extrusion after Medial Meniscus Posterior Root Tear Analyzed by Using Magnetic Resonance Imaging.使用磁共振成像分析内侧半月板后根撕裂后内侧半月板挤出的时间依赖性增加
Knee Surg Relat Res. 2019 Jun 1;31(2):120-125. doi: 10.5792/ksrr.18.059.
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Description of a surgical technique of medial meniscus root repair: a fixation technique with two simple stiches under an expected initial tension.内侧半月板根部修复手术技术描述:一种在预期初始张力下采用两根简单缝线的固定技术。
Eur J Orthop Surg Traumatol. 2019 Apr;29(3):705-709. doi: 10.1007/s00590-018-2347-z. Epub 2018 Nov 29.
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内侧半月板后根部撕裂经或不经胫骨高位截骨修复的疗效:一项系统评价。
BMC Musculoskelet Disord. 2023 Jun 6;24(1):464. doi: 10.1186/s12891-023-06520-9.
Meniscal Extrusion Progresses Shortly after the Medial Meniscus Posterior Root Tear.
内侧半月板后根部撕裂后不久,半月板挤出即会进展。
Knee Surg Relat Res. 2017 Dec 1;29(4):295-301. doi: 10.5792/ksrr.17.027.
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Tensile strength of the pullout repair technique for the medial meniscus posterior root tear: a porcine study.内侧半月板后根撕裂的拉出修复技术的拉伸强度:一项猪的研究。
Int Orthop. 2017 Oct;41(10):2113-2118. doi: 10.1007/s00264-017-3561-8. Epub 2017 Jul 14.
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A giraffe neck sign of the medial meniscus: A characteristic finding of the medial meniscus posterior root tear on magnetic resonance imaging.内侧半月板的长颈鹿颈征:磁共振成像上内侧半月板后根部撕裂的特征性表现。
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Orthop Traumatol Surg Res. 2017 May;103(3):367-371. doi: 10.1016/j.otsr.2017.01.005. Epub 2017 Feb 24.
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9
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Orthop Traumatol Surg Res. 2016 Nov;102(7):951-954. doi: 10.1016/j.otsr.2016.06.013. Epub 2016 Aug 25.
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Pullout Fixation of Posterior Medial Meniscus Root Tears: Correlation Between Meniscus Extrusion and Midterm Clinical Results.后内侧半月板根部撕裂的拔出固定:半月板挤出与中期临床结果之间的相关性
Am J Sports Med. 2017 Jan;45(1):42-49. doi: 10.1177/0363546516662445. Epub 2016 Oct 1.