Department of Orthopaedic Surgery, Southern California Permanente Medical Group, San Diego, California, USA.
Surgical Outcomes and Analysis, Kaiser Permanente, San Diego, California, USA.
Am J Sports Med. 2021 Apr;49(5):1296-1304. doi: 10.1177/0363546521997101. Epub 2021 Mar 5.
An intact meniscus is considered a secondary stabilizer of the knee after anterior cruciate ligament reconstruction (ACLR). While loss of the meniscus can increase forces on the anterior cruciate ligament graft after reconstruction, it is unclear whether this increased loading affects the success of the graft after ACLR.
To identify the risk of subsequent knee surgery when meniscectomy, either partial or total, is performed at the time of index ACLR.
Cohort study; Level of evidence, 3.
We conducted a matched cohort study using data from the Kaiser Permanente Anterior Cruciate Ligament Reconstruction Registry. Patients were identified who had a primary ACLR performed between January 1, 2005 and December 31, 2016, with up to 12 years of follow-up. The study sample comprised patients with ACLR who had a lateral meniscectomy (n = 2581), medial meniscectomy (n = 1802), or lateral and medial meniscectomies (n = 666). For each meniscectomy subgroup, patients with ACLR alone were matched to patients with a meniscectomy on a number of patient and procedure characteristics. After the application of matching, Cox proportional hazards regression was used to evaluate the risk of aseptic revision, while competing risks regression was used to evaluate the risk of cause-specific ipsilateral reoperation between meniscectomy and ACLR alone. Analysis was performed for each meniscectomy subgroup.
After the application of matching, we failed to observe a difference in aseptic revision risk for patients with ACLR and a meniscectomy-lateral (hazard ratio [HR], 0.80; 95% CI, 0.63-1.02), medial (HR, 0.95; 95% CI, 0.70-1.29), or both (HR, 1.25; 95% CI, 0.77-2.04)-as compared with ACLR alone. When compared with patients who had ACLR alone, patients with a lateral meniscectomy had a higher risk for subsequent lateral meniscectomy (HR, 1.89; 95% CI, 1.18-3.02; = .008), and those with a medial meniscectomy had a lower risk for manipulation under anesthesia (HR, 0.13; 95% CI, 0.02-0.92; = .041).
No difference in aseptic revision risk was observed for patients undergoing primary ACLR between groups with and without meniscectomy at the time of index surgery. Partial lateral meniscectomy at the time of index ACLR did associate with a higher risk of subsequent lateral meniscectomy.
在前交叉韧带重建（ACLR）后，完整的半月板被认为是膝关节的次要稳定器。虽然半月板的丧失会增加重建后前交叉韧带移植物上的力，但尚不清楚这种增加的负荷是否会影响 ACLR 后移植物的成功。
当在指数 ACLR 时进行半月板切除术（部分或全部）时，确定随后进行膝关节手术的风险。
队列研究；证据水平，3 级。
我们使用 Kaiser Permanente 前交叉韧带重建登记处的数据进行了匹配队列研究。确定了 2005 年 1 月 1 日至 2016 年 12 月 31 日期间进行初次 ACLR 的患者，并进行了长达 12 年的随访。研究样本包括进行 ACLR 的患者，他们接受了外侧半月板切除术（n = 2581）、内侧半月板切除术（n = 1802）或外侧和内侧半月板切除术（n = 666）。对于每个半月板切除术亚组，在许多患者和手术特征方面，将 ACLR 患者与单独接受 ACLR 的患者相匹配。在应用匹配后，使用 Cox 比例风险回归评估无菌翻修的风险，而使用竞争风险回归评估半月板切除术和单独 ACLR 之间特定于病因的同侧再手术的风险。对每个半月板切除术亚组进行分析。
在应用匹配后，我们未观察到接受 ACLR 和半月板切除术-外侧（危险比 [HR]，0.80；95%置信区间，0.63-1.02）、内侧（HR，0.95；95%置信区间，0.70-1.29）或两者（HR，1.25；95%置信区间，0.77-2.04）的患者无菌翻修风险存在差异。与单独接受 ACLR 的患者相比，接受外侧半月板切除术的患者随后行外侧半月板切除术的风险更高（HR，1.89；95%CI，1.18-3.02；P =.008），而接受内侧半月板切除术的患者接受全身麻醉下关节内手术的风险更低（HR，0.13；95%CI，0.02-0.92；P =.041）。
在指数手术时接受初次 ACLR 的患者中，半月板切除术组与无半月板切除术组之间无菌翻修风险无差异。在指数 ACLR 时进行部分外侧半月板切除术与随后行外侧半月板切除术的风险增加相关。
