Children's Healthcare of Atlanta, Atlanta, GA.
Boston Children's Hospital, Boston, MA.
J Pediatr Orthop. 2021 Jan;41(1):23-27. doi: 10.1097/BPO.0000000000001695.
Historically, total meniscectomy was recommended as the treatment for a symptomatic discoid meniscus. Improved meniscal repair techniques and inferior long-term outcomes associated with meniscectomy have resulted in a trend toward meniscal preservation, with saucerization and repair of meniscocapsular tears. Reoperation rates after treatment of torn discoid menisci vary, with some series reporting high rates of reinjury and reoperation. The purpose of this study is to describe the intermediate-term outcomes of pediatric patients treated with saucerization and meniscocapsular repair of discoid lateral menisci with peripheral rim instability.
A single-institution retrospective review was performed of consecutive patients less than 18 years of age treated with saucerization and repair for a meniscocapsular tear of a discoid lateral meniscus from 2013 to 2017. All patients had a minimum 24-month follow-up. A chart review was performed to describe tear location and repair type. The primary outcomes were revision meniscus surgery and Pedi-International Knee Documentation Committee and Tegner activity scores obtained at the final follow-up.
In total, 32 knees in 30 patients, including 15 males and 15 females with a mean age of 12 years (range, 5 to 17 y), were included. Tear patterns included anterior meniscocapsular (14 knees), posterior meniscocapsular (16 knees), and both anterior and posterior meniscocapsular (2 knees). Arthroscopic saucerization and meniscocapsular repair were performed in all knees. Repair types were outside-in (10 knees), inside-out (8 knees), all-inside (8 knees), and hybrid (6 knees). The mean follow-up was 54 months (range, 30 to 86 mo). Three knees (9%) underwent revision meniscus surgery, including 2 all-inside repairs and 1 partial meniscectomy. At the final follow-up, mean International Knee Documentation Committee score was 96 (range, 82 to 100). A total of 89% of patients reported returning to the same or higher level of activity following surgery.
Saucerization of discoid lateral menisci with repair of meniscocapsular tears is associated with low rates of revision surgery and good intermediate-term outcomes.
Level IV.
historically, total meniscectomy was recommended as the treatment for a symptomatic discoid meniscus. Improved meniscal repair techniques and inferior long-term outcomes associated with meniscectomy have resulted in a trend toward meniscal preservation, with saucerization and repair of meniscocapsular tears. Reoperation rates after treatment of torn discoid menisci vary, with some series reporting high rates of reinjury and reoperation. The purpose of this study is to describe the intermediate-term outcomes of pediatric patients treated with saucerization and meniscocapsular repair of discoid lateral menisci with peripheral rim instability.
背景： historically, total meniscectomy 曾被推荐为治疗有症状的盘状半月板的方法。随着半月板修复技术的改善和与半月板切除术相关的较差的长期结果，半月板保存的趋势已经出现，采用盘状外侧半月板的半月板成形术和半月板囊撕裂修复术。撕裂的盘状半月板治疗后的再手术率各不相同，有些系列报道的再损伤和再手术率较高。本研究的目的是描述采用半月板成形术和半月板囊撕裂修复术治疗外侧半月板盘状撕裂伴边缘不稳定的小儿患者的中期结果。
对 2013 年至 2017 年连续接受盘状外侧半月板的半月板囊撕裂的半月板成形术和修复术的小于 18 岁的患者进行了单中心回顾性研究。所有患者的随访时间均至少为 24 个月。对病历进行了回顾，以描述撕裂的位置和修复类型。主要结局是最终随访时的翻修半月板手术和 Pedi-International Knee Documentation Committee 评分和 Tegner 活动评分。
共纳入 30 例患者的 32 个膝关节，包括 15 例男性和 15 例女性，平均年龄为 12 岁（范围 5 至 17 岁）。撕裂模式包括前半月板囊（14 个膝关节）、后半月板囊（16 个膝关节）和前、后半月板囊（2 个膝关节）。所有膝关节均行关节镜下半月板成形术和半月板囊修补术。修复类型包括外到内（10 个膝关节）、内到外（8 个膝关节）、全内（8 个膝关节）和混合（6 个膝关节）。平均随访时间为 54 个月（范围 30 至 86 个月）。3 个膝关节（9%）行翻修半月板手术，包括 2 例全内修复和 1 例部分半月板切除术。最终随访时，平均国际膝关节文献委员会评分 96 分（范围 82 至 100 分）。89%的患者报告术后恢复到相同或更高水平的活动。
盘状外侧半月板的半月板成形术结合半月板囊撕裂的修复与较低的翻修手术率和较好的中期结果相关。
四级。
