稳定膝关节的半月板外科损伤：1424 例前瞻性系列中的解剖学描述。

Surgical meniscal lesions in stable knee: Topographic description in a prospective series of 1424 cases.

机构信息

Service de Chirurgie Orthopédique, CHU Lyon Croix-Rousse, Centre Médical d'Excellence FIFA, Hospices Civils de Lyon, 69004 Lyon, France.

出版信息

Orthop Traumatol Surg Res. 2021 Apr;107(2):102812. doi: 10.1016/j.otsr.2021.102812. Epub 2021 Jan 22.

DOI:10.1016/j.otsr.2021.102812

PMID:33486079

Abstract

BACKGROUND

The epidemiology of meniscal lesions in stable knee has been a focus of study, but exact topography is not clearly known. Tear patterns are thought to differ between pathologies and the difference between a traumatic and a degenerative pattern is not always easy to draw. In 2010, ISAKOS designed a questionnaire to standardize assessment. The main objective of present study was to detail the precise topography and type of surgical meniscal patterns (i.e., that were operated on) in stable knee. Secondary objectives were to assess the relationship of tear pattern and cartilage lesions in the tibiofemoral compartment, and to analyze age at onset.

HYPOTHESES

The study hypotheses were that tear pattern correlates with cartilage lesions, and that mean age differs according to tear pattern, with younger onset of vertical tears, in surgery@ patients.

PATIENTS & METHODS: Data collection for this descriptive epidemiological study was prospective, on systematic ISAKOS questionnaire. 1424 isolated meniscal tears in stable knee, operated on between 2010 and 2017, were included: 253 lateral meniscus (LM), and 1171 medial meniscus (MM). Mean age at surgery was respectively 36 and 47 years.

RESULTS

The most frequent tear pattern was vertical (39% in LM, 38% in MM). The more frequent locations were posterior+midpart and midpart (22% each) in LM, and posterior in MM (56%). Tears were mainly peripheral (zone 1) in LM (46%), and zone 2 in MM (46%). Mean age in medial vertical tears was 43±14 years, significantly lower (p<0.001) than in other types. Meniscal tear pattern correlated significantly with medial tibiofemoral cartilage lesion (p<0.001).

DISCUSSION

The present study described the precise topography of isolated meniscal tears in stable knee in a large sample, using the ISAKOS questionnaire. The study hypotheses were confirmed for the medial but not the lateral meniscus.

LEVEL OF EVIDENCE

III; well-conducted non-randomized prospective comparative study.

摘要

背景

稳定膝关节半月板损伤的流行病学一直是研究的焦点，但确切的病变部位尚不清楚。人们认为撕裂模式在不同的病变中有所不同，外伤性和退行性撕裂模式之间的区别并不总是那么容易区分。2010 年，ISAKOS 设计了一个问卷来规范评估。本研究的主要目的是详细描述稳定膝关节半月板手术（即接受手术的半月板）的精确病变部位和类型。次要目的是评估撕裂模式与胫骨股骨间室软骨损伤的关系，并分析发病年龄。

假设

研究假设是撕裂模式与软骨损伤相关，并且根据撕裂模式，手术患者的平均年龄存在差异，即垂直撕裂的发病年龄较早。

患者和方法

这项描述性流行病学研究的数据收集是前瞻性的，基于系统的 ISAKOS 问卷。纳入了 2010 年至 2017 年间在稳定膝关节接受手术的 1424 例孤立性半月板撕裂患者：253 例外侧半月板（LM）和 1171 例内侧半月板（MM）。手术时的平均年龄分别为 36 岁和 47 岁。

结果

最常见的撕裂模式是垂直型（LM 占 39%，MM 占 38%）。LM 最常见的部位是后+中份和中份（各占 22%），而 MM 则是后份（占 56%）。撕裂主要是外周（1 区）的 LM（46%）和 MM 的 2 区（46%）。内侧垂直撕裂的平均年龄为 43±14 岁，明显低于其他类型（p<0.001）。半月板撕裂模式与内侧胫骨股骨软骨损伤显著相关（p<0.001）。