Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A.
Walter Reed National Military Medical Center, Orthopaedic Surgery Department, Uniformed Services University of Health Sciences, Bethesda, Maryland, U.S.A.
Arthroscopy. 2021 Mar;37(3):792-794. doi: 10.1016/j.arthro.2021.01.003. Epub 2021 Jan 14.
Technical advancements in meniscal repairs have greatly contributed to the ability to repair a variety of meniscal tears that were once thought untreatable. The gold-standard treatment for arthroscopic meniscal body repair remains an inside-out technique. The advantages of this technique are innate to the low-profile nature of the suture-passing construct, which allows for perpendicular access to tears with the benefit of multiple fixation points, in contrast to often bulkier all-inside repair devices. This technique requires a posteromedial or posterolateral incision for safe suture passing and needle retrieval and necessitates a surgical team experienced in this method of repair. However, the newest generation of all-inside devices has allowed for more facile placement of a variety of suture types. The all-inside repair technique includes both capsular-based and meniscal-based fixation, is not limited by a need for additional experienced surgical personnel to pass and retrieve needles, and does not require additional incisions. Regardless of fixation type, meniscal repair has been shown to improve long-term functional scores when compared with meniscectomy. Additionally, biological adjuncts have been introduced into the repair algorithm to improve healing rates when performing isolated meniscal repairs. Preparing the healing site with abrasion or trephination creates vascular channels that can facilitate repair. Intercondylar-notch marrow venting attempts to replicate the environment created by anterior cruciate ligament drilling for which healing rates are notably higher than those with isolated meniscal repairs. The use of fibrin clots in inside-out meniscal repairs with suturing of the clot to the area of the tear has also shown promising early healing rates on both magnetic resonance imaging and second-look arthroscopy. Finally, biological adjuncts such as platelet-rich plasma and concentrated bone marrow aspirate have shown both early clinical and radiographic improvements in Level IV case series, but further research is needed to more definitively measure their utility in the setting of meniscal repair.
半月板修复技术的进步极大地提高了治疗各种曾经被认为无法治疗的半月板撕裂的能力。关节镜下半月板体部修复的金标准治疗仍然是一种由外向内的技术。这种技术的优点是其缝线传递结构的低轮廓特性所固有,这使得可以通过多个固定点垂直进入撕裂处,与通常更笨重的全内修复装置形成对比。该技术需要后内侧或后外侧切口以安全地进行缝线传递和针的取出,并需要一支在这种修复方法方面经验丰富的手术团队。然而,最新一代的全内装置允许更方便地放置各种缝线类型。全内修复技术包括基于囊的和基于半月板的固定,不受需要额外有经验的手术人员来传递和取出针的限制,也不需要额外的切口。无论固定类型如何,与半月板切除术相比,半月板修复都显示出改善长期功能评分的效果。此外,在进行单独的半月板修复时,已经引入了生物附加物来提高愈合率。用研磨或环钻处理修复部位可创建血管通道,有助于修复。髁间脊骨髓通风试图复制前交叉韧带钻孔所创造的环境,其愈合率明显高于单独半月板修复。在半月板缝合修复中使用纤维蛋白凝块,将凝块缝合到撕裂部位,也显示出磁共振成像和二次关节镜检查的早期愈合率有希望。最后,富血小板血浆和浓缩骨髓抽吸等生物附加物在 IV 级病例系列中显示出早期临床和放射学改善,但需要进一步的研究来更明确地衡量它们在半月板修复中的效用。
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