Okazaki Yuki, Furumatsu Takayuki, Kamatsuki Yusuke, Okazaki Yoshiki, Masuda Shin, Hiranaka Takaaki, Kodama Yuya, Miyazawa Shinichi, Ozaki Toshifumi
Department of Orthopedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan.
Department of Orthopedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan.
Orthop Traumatol Surg Res. 2020 May;106(3):469-473. doi: 10.1016/j.otsr.2019.10.022. Epub 2020 Apr 8.
Lateral meniscus (LM) posterior root tear (PRT) is often associated with anterior cruciate ligament (ACL) injury and can result in rotational instability, joint overloading, and degenerative changes in the knee. Improved rotational stability and kinematics have been reported after LMPRT repair. However, it is unclear what repair technique can achieve the greatest reduction in LM extrusion (LME).
We hypothesized that transtibial pullout repair would decrease LME to a greater extent than other repair techniques.
Seventeen patients with ACL injury and complete LMPRT were evaluated. Nine underwent ACL reconstruction (ACLR) and transtibial pullout repair, and eight underwent ACLR and other repairs such as inside-out suturing. Double-bundle ACLR was performed using hamstring tendons, and LMPRT pullout repair was performed through the bone tunnel for the posterolateral bundle. Magnetic resonance imaging was performed immediately preoperatively and at>6 months postoperatively, and LME was measured from coronal images only.
A significantly greater decrease in the value of LME from pre- to postoperative measurement was observed in the transtibial pullout repair group (-0.5±0.7mm) than in the other-repair group (1.0±0.9mm, p<0.01). Pre- and postoperative LME measurements were not significantly different between the two groups.
The most important finding of this study was that transtibial pullout repair resulted in a greater decrease in LME than other repair techniques in patients with ACL injury and LMPRT. This technique might be useful for restoring hoop tension by decreasing LME.
III, comparative retrospective study.
外侧半月板（LM）后根部撕裂（PRT）常与前交叉韧带（ACL）损伤相关，可导致旋转不稳定、关节负荷过重以及膝关节退变。据报道，外侧半月板后根部撕裂修复术后旋转稳定性和运动学得到改善。然而，尚不清楚哪种修复技术能最大程度减少外侧半月板挤出（LME）。
我们假设经胫骨拉出式修复比其他修复技术能更大程度地减少外侧半月板挤出。
对17例ACL损伤且外侧半月板后根部完全撕裂的患者进行评估。9例接受ACL重建（ACLR）及经胫骨拉出式修复，8例接受ACLR及其他修复，如由内向外缝合。采用腘绳肌腱进行双束ACLR，通过后外侧束的骨隧道进行外侧半月板后根部拉出式修复。术前即刻及术后6个月以上行磁共振成像检查，仅从冠状位图像测量外侧半月板挤出。
经胫骨拉出式修复组术前至术后外侧半月板挤出值的下降幅度（-0.5±0.7mm）显著大于其他修复组（1.0±0.9mm，p<0.01）。两组术前及术后外侧半月板挤出测量值无显著差异。
本研究最重要的发现是，对于ACL损伤和外侧半月板后根部撕裂的患者，经胫骨拉出式修复比其他修复技术能更大程度地减少外侧半月板挤出。该技术可能有助于通过减少外侧半月板挤出恢复环向张力。
III级，比较性回顾性研究。
