Department of Sports Orthopaedics, Hoshigaoka Medical Center, Hirakata, Osaka, Japan.
Department of Sports Orthopaedics, Osaka Rosai Hospital, Sakai, Osaka, Japan.
Am J Sports Med. 2021 Mar;49(3):684-692. doi: 10.1177/0363546520981976. Epub 2021 Jan 15.
Meniscal function after repair of longitudinal tears of the lateral meniscus (LM) with anterior cruciate ligament reconstruction (ACLR) has not been comprehensively investigated.
To evaluate not only the clinical outcomes and radiographic findings of patients who underwent repair of longitudinal tears of the LM combined with ACLR but also the healing status of the repaired meniscus and changes in chondral status with second-look arthroscopy.
Case series; Level of evidence, 4.
Among 548 patients who underwent primary anatomic ACLR at our institution between 2010 and 2017, 39 who had concomitant longitudinal tears of the LM and underwent repair were studied. During follow-up for more than 2 years, all patients were evaluated clinically (pain, range of motion, swelling, and knee instability) and with imaging (plain radiograph and magnetic resonance imaging [MRI]), and compared with a matched control group (based on age, sex, body mass index, and follow-up period) without any concomitant injuries who underwent ACLR. Measurements on MRI were recorded preoperatively, immediately after surgery, and at final follow-up, and the change in the values over time was assessed. Of the 39 patients in each group, 24 were assessed by second-look arthroscopy with hardware removal 2 years postoperatively.
The mean follow-up times of the study and control group were at a mean of 42.4 and 45.4 months, respectively. There were no significant differences in clinical findings, lateral joint space narrowing on radiographs, and chondral status at the lateral compartment between groups, whereas lateral and posterior meniscal extrusion on MRI progressed significantly in the study group (0.43 ± 1.0 mm vs -0.29 ± 1.1 mm, = .003; 1.9 ± 1.9 mm vs 0.14 ± 1.1 mm, < .0001, respectively). Second-look arthroscopy revealed complete healing in 12 patients (50%), partial healing in 9 (37.5%), and failure in 3 (12.5%) in the study group, and no new tear in the control group.
The clinical and imaging outcomes after repair of longitudinal tears of the LM combined with anatomic ACLR were successful and comparable with those after isolated ACLR without any other injuries at 42 months postoperatively, although meniscal extrusion showed progression on coronal/sagittal MRI. Based on the MRI findings and the result that only half of patients achieved complete healing, meniscal function could not be fully restored even after repair. Although degenerative changes were not apparent, longer-term follow-up is needed.
前交叉韧带重建（ACL）合并外侧半月板（LM）纵向撕裂的半月板修复后功能尚未得到全面研究。
不仅评估 ACL 合并 LM 纵向撕裂修复患者的临床和影像学结果，还评估半月板愈合状态和二次关节镜检查时软骨状态的变化。
病例系列；证据水平，4 级。
在我院于 2010 年至 2017 年期间行初次解剖 ACLR 的 548 例患者中，对 39 例伴有 LM 纵向撕裂且接受修复的患者进行了研究。在超过 2 年的随访中，所有患者均接受了临床（疼痛、活动范围、肿胀和膝关节不稳定）和影像学（平片和磁共振成像[MRI]）评估，并与未合并其他损伤的匹配对照组（基于年龄、性别、体重指数和随访时间）进行了比较。在术前、术后即刻和末次随访时记录 MRI 测量值，并评估随时间的变化。每组 39 例患者中有 24 例在术后 2 年接受了二次关节镜检查并去除内固定。
研究组和对照组的平均随访时间分别为平均 42.4 个月和 45.4 个月。两组间临床发现、放射学外侧关节间隙变窄和外侧间室软骨状态无显著差异，而 MRI 上外侧和后半月板外突显著进展（0.43 ± 1.0 毫米 vs -0.29 ± 1.1 毫米， =.003；1.9 ± 1.9 毫米 vs 0.14 ± 1.1 毫米， <.0001）。研究组二次关节镜检查显示完全愈合 12 例（50%）、部分愈合 9 例（37.5%）、失败 3 例（12.5%），对照组无新撕裂。
LM 纵向撕裂合并解剖 ACLR 修复后的临床和影像学结果成功，与单独 ACLR 无其他损伤的结果在术后 42 个月时相当，尽管冠状/矢状面 MRI 显示半月板外突进展。基于 MRI 结果和仅有一半患者达到完全愈合的结果，即使修复后，半月板功能也不能完全恢复。虽然退行性改变不明显，但仍需要长期随访。
