Nagashima Masaki, Otani Toshiro, Takeshima Kenichiro, Seki Hiroyuki, Ishii Ken
Department of Orthopaedic Surgery, International University of Health and Welfare, Mita Hospital, Tokyo.
Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Narita City, Chiba.
Arthrosc Sports Med Rehabil. 2019 Dec 18;2(1):e1-e6. doi: 10.1016/j.asmr.2019.10.002. eCollection 2020 Feb.
To evaluate the clinical results following arthroscopic surgery in patients with anomaly of the anterior horn of the medial meniscus (AHMM) that was found unexpectedly during surgery and discuss whether resection is necessary in patients without anteromedial knee pain (AMKP).
Between May 2014 and April 2017, a total of 387 knee arthroscopies in 379 patients were performed. Among these, 11 knees in 11 patients showed an anomalous insertion of the AHMM (incidence, 2.8%), and all 11 patients were included in this study. For these 11 patients, medical records including preoperative diagnosis, arthroscopic findings, and pre- and postoperative clinical evaluations were analyzed.
None of the patients complained of AMKP before arthroscopy. Two patients were diagnosed with lateral meniscus injury and the other 9 patients were diagnosed with medial meniscus injury. All anomalies of the AHMM were found incidentally during arthroscopic surgery. The anomaly formed a band-like structure arising from the anterior portion of the medial meniscus and was attached to the anterior aspect of the ACL and femoral intercondylar notch. All 11 patients underwent partial meniscectomy, but anomalies of the AHMM were not resected. One patient was excluded from clinical evaluation, as that patient required subsequent total knee arthroplasty due to osteoarthritis. For the other 10 patients, mean follow-up was 36.8 months (range, 26-61 months). Knee pain was relieved, and none developed postoperative AMKP. Mean Lysholm score improved significantly from 55.9 to 91.2 ( < .001).
The incidence of the anomaly was 2.8% in our study. If the patient has no AMKP before arthroscopic surgery, anomaly of the AHMM is a silent lesion that does not warrant resection.
Level IV, therapeutic case series.
评估手术中意外发现内侧半月板前角（AHMM）异常的患者行关节镜手术后的临床结果，并讨论在无膝前内侧疼痛（AMKP）的患者中是否有必要进行切除。
2014年5月至2017年4月，对379例患者共进行了387例膝关节镜检查。其中，11例患者的11个膝关节显示AHMM插入异常（发生率为2.8%），这11例患者均纳入本研究。对这11例患者的病历进行分析，包括术前诊断、关节镜检查结果以及术前和术后的临床评估。
所有患者在关节镜检查前均无AMKP主诉。2例患者诊断为外侧半月板损伤，另外9例患者诊断为内侧半月板损伤。所有AHMM异常均在关节镜手术中偶然发现。该异常形成一个带状结构，起自内侧半月板前部，附着于前交叉韧带（ACL）前方和股骨髁间切迹。11例患者均接受了部分半月板切除术，但未切除AHMM异常。1例患者因骨关节炎需要后续行全膝关节置换术，被排除在临床评估之外。对其余10例患者，平均随访36.8个月（范围26 - 61个月）。膝关节疼痛缓解，无一例发生术后AMKP。Lysholm评分平均从55.9显著提高到91.2（P <.001）。
在我们的研究中，该异常的发生率为2.8%。如果患者在关节镜手术前无AMKP，AHMM异常是一种无症状病变，无需切除。
IV级，治疗性病例系列。
