内侧副韧带的“馅饼皮”技术在关节镜下由外向内技术修复内侧半月板（伴或不伴前交叉韧带重建）中的作用：一种令人满意的修复技术。
The Role of the Pie-Crusting Technique of the Medial Collateral Ligament in the Arthroscopic Inside-out Technique for Medial Meniscal Repair With or Without Anterior Cruciate Ligament Reconstruction: A Satisfactory Repair Technique.
作者信息
Erdem Mehmet, Bayam Levent, Erdem Ahmet Can, Gulabi Deniz, Akar Abdulhalim, Kochai Alauddin
机构信息
Medical School, Sakarya University, Sakarya, Turkey.
Bezmialem Vakif University, Istanbul, Turkey.
出版信息
Arthrosc Sports Med Rehabil. 2020 Dec 26;3(1):e31-e37. doi: 10.1016/j.asmr.2020.08.005. eCollection 2021 Feb.
PURPOSE
To assess the results of a technique for pie crusting of the medial collateral ligament (MCL) and inside-out medial meniscal repair and perform a comparison with the literature.
METHODS
This retrospective study consisted of electronic data collection between 2012 and 2017 with a minimum of 2 years' follow-up. The inclusion criteria were the presence of difficult medial meniscal tears with joint tightness requiring pie crusting and the presence of acute or chronic tears of zone I or II with or without anterior cruciate ligament reconstruction (ACLR) using hamstring autograft during the same session. The primary outcome of the study was the achievement of good results with the aforementioned technique. There was no control group. All patients underwent assessments at 1, 2, and 6 months in outpatient clinics. At 6 months, the Lysholm knee score was calculated. For statistical analysis, the Social Science Statistics online program was used to perform descriptive analysis and assess any associations between the variables.
RESULTS
This study included 53 patients from a single surgeon's practice; of these patients, 31 underwent additional ACLR using hamstring autograft during the same session. The mean age was 29.43 years (range, 14-49 years), and the mean increase in the medial joint space width was 3.21 mm (range, 2-5 mm) with pie crusting. At 6 months, the average Lysholm score was 93 (range, 67-100) and the average visual analog scale score was 0.8 (range, 0-4). There was no meaningful association between age, tear pattern, chronicity of tear, joint space width obtained after pie crusting, and associated anterior cruciate ligament tear. Patients returned to their daily activity level at 4.5 months on average and returned to sporting activities at 7.4 months on average. Saphenous nerve symptoms were observed in 5 patients, but no infection or instability was documented in the follow-up period.
CONCLUSIONS
In this study, we obtained good outcomes using arthroscopic inside-out medial meniscal repair combined with pie crusting for the release of the MCL, with or without ACLR.
LEVEL OF EVIDENCE
Level IV, therapeutic case series.
目的
评估内侧副韧带（MCL）“饼皮样”处理及由外向内半月板修复技术的效果，并与文献进行比较。
方法
本回顾性研究通过电子数据收集2012年至2017年期间的数据，随访时间至少为2年。纳入标准为存在伴有关节紧绷需要“饼皮样”处理的复杂内侧半月板撕裂，以及存在I区或II区的急性或慢性撕裂，且在同一手术中使用腘绳肌自体移植物进行或未进行前交叉韧带重建（ACLR）。本研究的主要结果是采用上述技术取得良好效果。无对照组。所有患者在门诊分别于1个月、2个月和6个月进行评估。在6个月时，计算Lysholm膝关节评分。为进行统计分析，使用社会科学统计在线程序进行描述性分析并评估变量之间的任何关联。
结果
本研究纳入了来自单一外科医生诊所的53例患者；其中31例患者在同一手术中还进行了腘绳肌自体移植物ACLR。平均年龄为29.43岁（范围14 - 49岁），“饼皮样”处理后内侧关节间隙宽度平均增加3.21mm（范围2 - 5mm）。在6个月时，平均Lysholm评分为93分（范围67 - 100），平均视觉模拟量表评分为0.8分（范围0 - 4）。年龄、撕裂模式、撕裂的慢性程度、“饼皮样”处理后获得的关节间隙宽度以及相关的前交叉韧带撕裂之间无有意义的关联。患者平均在4.5个月恢复日常活动水平，平均在7.4个月恢复体育活动。5例患者出现隐神经症状，但随访期间未记录到感染或不稳定情况。
结论
在本研究中，我们采用关节镜下由外向内半月板修复联合“饼皮样”处理MCL松解术，无论是否进行ACLR，均取得了良好的效果。
证据级别
IV级，治疗性病例系列。
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