改良 Mason-Allen 缝合技术联合胫骨高位截骨术治疗内侧半月板后根部撕裂可促进修复根部愈合，抑制骨关节炎进展。
Remodified Mason-Allen suture technique concomitant with high tibial osteotomy for medial meniscus posterior root tears improved the healing of the repaired root and suppressed osteoarthritis progression.
机构信息
Department of Orthopedic Surgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Munhwa-dong, Jung-gu, Daejeon, 301-721, South Korea.
出版信息
Knee Surg Sports Traumatol Arthrosc. 2021 Apr;29(4):1258-1268. doi: 10.1007/s00167-020-06151-w. Epub 2020 Jul 25.
PURPOSE
To evaluate the results of the remodified Mason-Allen suture technique concomitant with high tibial osteotomy (HTO) for medial meniscal posterior root tears (MMPRTs). The hypothesis was that this procedure would improve clinical results, prevent progression of knee osteoarthritis and increase the healing rate of the repaired root.
METHODS
Total 17 patients of mean 51.5 ± 4.4 years who were underwent this combined procedure for MMPRT completed this study. Lysholm and Hospital for Special Surgery (HSS) scores, Kellgren-Lawrence (KL) grade reflecting osteoarthritis progression were evaluated preoperatively and at the last follow-up. Medial meniscus extrusion (MME) was measured on magnetic resonance imaging preoperatively and at mean 26.1 ± 2.3 months postoperatively. Second-look arthroscopy was performed at mean 25.1 ± 5.3 months postoperatively. The healing status of the repaired root was classified as complete, partial and failed healing. The Outerbridge (OB) grade of the medial femoral condyle (MFC) was compared between index surgery and second-look arthroscopy.
RESULTS
Mean follow-up duration was 66.4 ± 6.5 months. Mean Lysholm and HSS mean scores improved significantly from preoperatively to the last follow-up: Lysholm: 56.9 ± 5.4 to 83.5 ± 6.0 (P < 0.001); HSS: 56.1 ± 6.0 to 81.7 ± 7.7 (P < 0.001). The mean mechanical alignment of the lower extremity was corrected from varus to the neutral range at the last follow-up. The preoperative KL grade was not significantly different from the KL grade at the last follow-up (P = 0.071). On MRI, mean MME increased from 3.0 ± 0.7 mm to 3.1 ± 0.7 mm (P = 0.046). Second-look arthroscopy showed 64.7% complete, 29.4% partial and 5.9% failed healing of the repaired root. The initial OB grade of the MFC showed no progression (P = 0.103).
CONCLUSIONS
The remodified Mason-Allen suture technique concomitant with HTO for MMPRTs significantly improved clinical outcomes and suppressed OA progression at 66.4 months. However, this procedure produced limited complete healing of the repaired roots in 64.7% of patients.
LEVEL OF EVIDENCE
IV.
目的
评估改良 Mason-Allen 缝合技术联合胫骨高位截骨术（HTO）治疗内侧半月板后根撕裂（MMPRT）的效果。假设该手术可以改善临床效果，预防膝关节骨关节炎的进展，并提高修复根的愈合率。
方法
本研究共纳入 17 名平均年龄为 51.5±4.4 岁的患者，均接受了该联合手术治疗 MMPRT。术前和末次随访时，采用 Lysholm 和特殊外科医院（HSS）评分、反映骨关节炎进展的 Kellgren-Lawrence（KL）分级进行评估。术前和平均 26.1±2.3 个月时行 MRI 测量内侧半月板外突（MME）。平均 25.1±5.3 个月时行二次关节镜检查。将修复根的愈合情况分为完全愈合、部分愈合和失败愈合。比较指数手术和二次关节镜检查时内侧股骨髁（MFC）的 Outerbridge（OB）分级。
结果
平均随访时间为 66.4±6.5 个月。Lysholm 和 HSS 平均评分从术前到末次随访均显著改善：Lysholm：56.9±5.4 至 83.5±6.0（P<0.001）；HSS：56.1±6.0 至 81.7±7.7（P<0.001）。末次随访时下肢的平均机械对线从内翻校正至中立位。术前 KL 分级与末次随访时的 KL 分级无显著差异（P=0.071）。MRI 显示，平均 MME 从 3.0±0.7mm 增加至 3.1±0.7mm（P=0.046）。二次关节镜检查显示，修复根的完全愈合占 64.7%，部分愈合占 29.4%，失败愈合占 5.9%。MFC 的初始 OB 分级无进展（P=0.103）。
结论
改良 Mason-Allen 缝合技术联合 HTO 治疗 MMPRT 可显著改善 66.4 个月时的临床效果，并抑制 OA 进展。然而，该手术仅使 64.7%的患者的修复根达到完全愈合。
证据等级
IV 级。
Zotero 插件