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解剖学上的膝关节变量导致外侧盘状半月板比非盘状外侧半月板的外侧半月板异体移植的结果更差。

Anatomical knee variables result in worse outcomes of lateral meniscal allograft transplantation with discoid lateral menisci than with nondiscoid lateral menisci.

机构信息

Department of Sports Medicine and Rehabilitation, Peking University Shenzhen Hospital, 1120 Lianhua Road, Futian District, Shenzhen, 518036, Guangdong, China.

出版信息

Knee Surg Sports Traumatol Arthrosc. 2021 Dec;29(12):4146-4153. doi: 10.1007/s00167-021-06509-8. Epub 2021 Mar 3.

Abstract

PURPOSE

To compare the clinical results of meniscal allograft transplantation (MAT) between patients with discoid lateral meniscus (DLM) and non-DLM (NDLM) and to analyse whether anatomical deformities cause worse clinical results in DLM patients.

METHODS

Patients who underwent unilateral MAT from 2005 to 2017, including 115 patients with DLMs or NDLMs, were included in this study. Clinical outcomes [International Knee Documentation Committee (IKDC) scores, Lysholm scores, Tegner scores, and visual analogue scale (VAS) scores] and radiographic and MRI data were assessed. Clinical outcomes and anatomical knee variables were analysed by multivariate stepwise regression.

RESULTS

After more than 2 years of follow-up, 9 patients were lost to follow-up, and 59 patients with DLM and 47 patients with NDLM were included. The mean postoperative results were significantly better than the preoperative data (P < 0.05) in both the DLM and NDLM groups. In addition, postoperative IKDC, Lysholm, and VAS scores but not Tegner scores were better in the NDLM group than in the DLM group. Several anatomical knee variables differed significantly between the NDLM and DLM groups and were associated with MAT outcomes. The condylar prominence ratio of the lateral and medial femoral condyles adjacent to the intercondylar notch and squaring of the lateral femoral condyle (the distance of the straight articular condylar surface) were independent factors significantly correlated with the Lysholm scores for MAT at last follow-up.

CONCLUSION

MAT improved knee function in both patients with DLM and patients with NDLM, but patients NDLM had better clinical outcomes than patients with DLM. The condylar prominence ratio and squaring of the lateral femoral condyle may underlie this result.

LEVEL OF EVIDENCE

III.

摘要

目的

比较盘状外侧半月板(DLM)和非盘状外侧半月板(NDLM)患者半月板同种异体移植(MAT)的临床结果,并分析解剖畸形是否导致 DLM 患者的临床结果更差。

方法

本研究纳入了 2005 年至 2017 年间接受单侧 MAT 的患者,包括 115 例 DLM 或 NDLM 患者。评估了临床结果[国际膝关节文献委员会(IKDC)评分、Lysholm 评分、Tegner 评分和视觉模拟评分(VAS)]和影像学及 MRI 数据。通过多元逐步回归分析临床结果和解剖膝关节变量。

结果

随访超过 2 年后,9 例患者失访,59 例 DLM 患者和 47 例 NDLM 患者纳入研究。两组患者术后结果均明显优于术前(P<0.05)。此外,NDLM 组术后 IKDC、Lysholm 和 VAS 评分优于 DLM 组,但 Tegner 评分无差异。NDLM 组和 DLM 组的几个解剖膝关节变量差异显著,与 MAT 结果相关。髁间窝毗邻的外侧和内侧股骨髁的髁突突出率和外侧股骨髁的方形化(直关节髁面的距离)是与末次随访时 MAT 的 Lysholm 评分显著相关的独立因素。

结论

MAT 改善了 DLM 和 NDLM 患者的膝关节功能,但 NDLM 患者的临床结果优于 DLM 患者。外侧股骨髁的髁突突出率和方形化可能是导致这一结果的原因。

证据等级

III 级。

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