School of Medicine, University of Turin, Turin, Italy.
Maria Pia Hospital, Turin, Italy.
Arthroscopy. 2021 May;37(5):1547-1553. doi: 10.1016/j.arthro.2020.11.053. Epub 2020 Dec 9.
To report the outcomes of arthroscopic meniscectomy (AM) at 20 years of follow-up through timing/rate of conversion to total knee replacement (TKR) and Knee Injury and Osteoarthritis Outcome Score (KOOS), focusing on detection of specific predictor variables for these outcomes, in patients 50 to 70 years old.
We performed a retrospective study of 289 patients, ages at surgery 50 to 70 years, with diagnosis of degenerative meniscal tear who underwent arthroscopic meniscectomy. We collected the following baseline data: age, sex, injured meniscus (medial, lateral, or both), knee alignment, osteoarthritis (OA), associated lesion identified during arthroscopy, and associated procedure performed during arthroscopy. At 20 years of follow-up, we collected rate and timing of TKR conversion, and we evaluated clinical outcomes with KOOS.
Female sex (P < .01), older age (P < .01), lateral meniscectomy (P = .02), malalignment (P = .03), and advanced chondral lesion (P < .01) were found to be significantly related to subsequent TKR. No significant correlation was found between amount of resection and subsequent TKR (P = .26). Negative predictor factors to obtain equal or superior to age- and sex-adjusted KOOS scores were age 60 to 70 years at time of AM (P = .03) and lateral meniscectomy (P = .02).
We report a 15.7% conversion rate at 20 years from AM to TKR and a mean time between surgeries of 7 years. Subsequent TKR in the 20 years after AM for degenerative meniscus tears were significantly associated with preoperative OA and chondral lesion (Kellgren Lawrence 2; Outerbridge >2), lateral meniscectomy, age at surgery, female sex, and malalignment. Furthermore, age >60 years, lateral meniscectomy, and concurrent anterior cruciate ligament reconstruction were negative predictors for poor clinical outcomes at 20 years. Therefore, if patients present with negative predictor factors, the AM should not be proposed as second-line treatment, and nonoperative management should be continued until TKR is unavoidable.
IV, case series.
报告膝关节镜半月板切除术（AM）20 年随访时通过全膝关节置换术（TKR）和膝关节损伤和骨关节炎结果评分（KOOS）的转换时间/转换率，并重点关注 50 至 70 岁患者中这些结果的特定预测变量的检测。
我们对 289 名年龄在 50 至 70 岁之间、接受过膝关节镜半月板切除术的退行性半月板撕裂患者进行了回顾性研究。我们收集了以下基线数据：年龄、性别、受伤的半月板（内侧、外侧或两者）、膝关节对线、骨关节炎（OA）、关节镜下发现的相关病变以及关节镜下进行的相关手术。在 20 年的随访中，我们收集了 TKR 转换的时间和速度，并使用 KOOS 评估了临床结果。
女性（P<.01）、年龄较大（P<.01）、外侧半月板切除术（P=0.02）、对线不良（P=0.03）和晚期软骨病变（P<.01）与随后的 TKR 显著相关。未发现切除量与随后的 TKR 之间存在显著相关性（P=0.26）。AM 时年龄在 60 至 70 岁（P=0.03）和外侧半月板切除术（P=0.02）是获得与年龄和性别调整后的 KOOS 评分相等或更高评分的负预测因素。
我们报告了 AM 后 20 年的 TKR 转化率为 15.7%，手术时间平均为 7 年。退行性半月板撕裂患者 AM 后 20 年内的后续 TKR 与术前 OA 和软骨病变（Kellgren Lawrence 2；Outerbridge >2）、外侧半月板切除术、手术时年龄、女性和对线不良显著相关。此外，年龄>60 岁、外侧半月板切除术和同时进行的前交叉韧带重建是 20 年时临床结果不佳的负预测因素。因此，如果患者存在负预测因素，则不应将 AM 作为二线治疗方案提出，应继续非手术治疗，直到 TKR 不可避免。
IV，病例系列。
