Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
Department of Orthopedic Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea.
Am J Sports Med. 2021 Mar;49(4):1005-1016. doi: 10.1177/0363546520988072. Epub 2021 Feb 18.
Increased varus alignment of the lower extremity is known to be a poor prognostic factor for the surgical repair for a medial meniscus root tear (MMRT). However, given the concept of constitutional varus, which is present in a substantial portion of the normal population, the generally accepted surgical indication for MMRT concerning a varus alignment of 5° may be unnecessarily narrow.
To compare the surgical outcomes of arthroscopic transtibial pullout repair of MMRT according to the degree of varus alignment of the lower extremity.
Cohort study; Level of evidence, 3.
Patients who underwent isolated arthroscopic transtibial pullout repair of MMRT between January 2010 and July 2017 at one institution and had a minimum follow-up of 2 years were included in this study. Patients were classified into 1 of 2 groups: the experimental group (n = 22) included patients with a preoperative hip-knee-ankle angle between 5° and 10° varus (mild to moderate varus alignment) and the control group (n = 51) included those with a preoperative hip-knee-ankle angle <5° varus (neutral alignment). Clinical scores and radiographic parameters were compared between the groups to assess surgical outcomes, which were statistically matched for potential confounders (age, body mass index, the severity of cartilage lesion) by use of the inverse probability of treatment weighting. A noninferiority trial was performed comparing the experimental and control groups in terms of subjective outcomes (International Knee Documentation Committee subjective and Lysholm scores) and objective outcomes (postoperative medial meniscal extrusion and the rate of osteoarthritis progression).
There were no statistically significant differences in surgical outcomes between the groups in subjective and objective aspects, which were consistent before and after inverse probability of treatment weighting. Apart from the clinical improvement observed in both groups, overall degenerative changes in the knee were found, although progression rates did not differ between the groups. In terms of the noninferiority trial, the overall surgical outcomes in the experimental group were not inferior to those in the control group.
The short-term surgical outcomes of arthroscopic transtibial pullout repair for MMRT of patients with mild to moderate varus alignment were not inferior to but rather comparable with those with neutral alignment in terms of subjective and objective aspects. Therefore, it would be inappropriate to exclude patients with a diagnosis of MMRT from being indicated for the surgery simply because of mild to moderate varus alignment.
下肢内翻对线增加被认为是内侧半月板后根部撕裂（MMRT）手术修复的预后不良因素。然而，鉴于在相当一部分正常人群中存在“固有内翻”的概念，一般接受的 MMRT 手术适应证为 5°的内翻对线可能过于狭窄。
比较根据下肢内翻对线程度行关节镜下经胫骨隧道半月板后根部撕裂修补术的手术效果。
队列研究；证据等级 3 级。
本研究纳入了 2010 年 1 月至 2017 年 7 月在一家机构接受单纯关节镜下经胫骨隧道半月板后根部撕裂修补术治疗且随访时间至少 2 年的患者。患者分为 2 组：实验组（n=22）包括术前髋膝踝角为 5°~10°内翻（轻度至中度内翻对线）的患者，对照组（n=51）包括术前髋膝踝角＜5°内翻（中立对线）的患者。比较两组的临床评分和影像学参数以评估手术效果，采用逆概率治疗加权法对年龄、体重指数、软骨损伤严重程度等潜在混杂因素进行统计学匹配。进行了一项非劣效性试验，比较实验组和对照组在主观结果（国际膝关节文献委员会主观评分和 Lysholm 评分）和客观结果（术后内侧半月板突出和骨关节炎进展率）方面的差异。
两组在主观和客观方面的手术效果均无统计学差异，且在逆概率治疗加权前后一致。除了两组都观察到的临床改善外，还发现了膝关节的整体退行性改变，但两组之间的进展率没有差异。就非劣效性试验而言，实验组的整体手术效果不劣于对照组。
对于轻度至中度内翻对线的 MMRT 患者，关节镜下经胫骨隧道半月板后根部撕裂修补术的短期手术效果在主观和客观方面与中立对线患者相当，因此，仅仅因为轻度至中度内翻对线就排除 MMRT 患者的手术适应证是不合适的。
