Department of Orthopaedic Surgery, Medical School, Democritus University of Thrace, University General Hospital of Alexandroupolis, 68100, Alexandroupolis, Greece.
Medical School, Democritus University of Thrace, University General Hospital of Alexandroupolis, 68100, Alexandroupolis, Greece.
Knee Surg Sports Traumatol Arthrosc. 2021 Sep;29(9):3037-3048. doi: 10.1007/s00167-020-06338-1. Epub 2020 Oct 31.
The purpose of this study was to systematically review case reports and case series about meniscal ossicle, to summarize existing evidence. Specifically, to identify the etiology, demographic characteristics, localization, clinical features, diagnostic procedures and treatment options of this rare entity. Although, case reports/ series are of low level of evidence, a systematic review of such studies can provide and help us to gain a better understanding and awareness of meniscal ossicle.
Two authors searched three online databases (MEDLINE, SCOPUS and GOOGLE SCHOLAR) from inception until March 2020 for the literature on meniscal ossicle. Inclusion criteria included case series, case reports and case-based reviews, available in full-text version, in English and that concern humans. Reports published in languages other than English were excluded, as well as articles with no electronic full text availability. Case reports using the term "meniscal ossicle" to describe an acute avulsion fracture of the tibial root of the meniscus, were also excluded.
Of 453 initial studies, 38 studies satisfied inclusion criteria. In total 169 patients were included of whom 107 (63%) were males and 62 (37%) were females. Mean age was 44 years (range 12-87). According to Magnetic resonance imaging findings, in 144 knees (86%) the ossicle was localized at the posterior root or horn of the medial meniscus. 60% of the patients had a history of trauma. The predominant symptom in 87% of patients was knee pain. In all patients was detected an intra-articular density structure in computed radiography. 76% had associated meniscal tear, 61% had intraarticular cartilage loss, 34% meniscal extrusion and 28% anterior cruciate ligament injury. Treatment modalities included conservative regimen in 40 patients, while 59 patients underwent surgical excision.
The most possible etiology of meniscal ossicle is posttraumatic heterotopic ossification and small occult bony avulsion fracture. It is commonly observed in individuals complaining about knee pain with history of antecedent trauma. The presence of a meniscal ossicle should alert the physician to the high likelihood of the patient having an associated meniscal tear, articular cartilage loss, ACL injury or meniscal extrusion. Along with the meniscal ossicle, the associated meniscal tear should be treated as well.
本研究旨在系统回顾关于半月板骨软骨瘤的病例报告和病例系列研究，以总结现有证据。具体而言，确定这种罕见实体的病因、人口统计学特征、定位、临床特征、诊断程序和治疗选择。尽管病例报告/系列属于低水平证据，但对这些研究的系统回顾可以帮助我们更好地理解和认识半月板骨软骨瘤。
两位作者从 1945 年开始在 MEDLINE、SCOPUS 和 GOOGLE SCHOLAR 这三个在线数据库中搜索有关半月板骨软骨瘤的文献，直至 2020 年 3 月。纳入标准包括病例系列、病例报告和病例报告综述，可提供全文版本，且为英文，涉及人类。排除非英文发表的报告以及无法获取电子全文的文章。使用“半月板骨软骨瘤”一词描述半月板胫骨根急性撕脱骨折的病例报告也被排除在外。
最初的 453 项研究中，有 38 项研究符合纳入标准。共有 169 名患者被纳入，其中 107 名（63%）为男性，62 名（37%）为女性。平均年龄为 44 岁（范围 12-87 岁）。根据磁共振成像（MRI）结果，在 144 个膝关节（86%）中，骨软骨瘤位于内侧半月板的后根或角。60%的患者有外伤史。87%的患者的主要症状是膝关节疼痛。在所有患者中，计算机放射摄影均检测到关节内密度结构。76%的患者存在半月板撕裂，61%的患者存在关节内软骨丢失，34%的患者存在半月板外突，28%的患者存在前交叉韧带损伤。治疗方式包括 40 名患者采用保守治疗，59 名患者采用手术切除。
半月板骨软骨瘤最可能的病因是创伤后异位骨化和小的隐匿性骨撕脱骨折。它常见于有膝关节疼痛且有先前创伤史的患者。半月板骨软骨瘤的存在应提醒医生患者很可能同时存在半月板撕裂、关节软骨丢失、前交叉韧带损伤或半月板外突。除了半月板骨软骨瘤，还应同时治疗相关的半月板撕裂。
