Department of Orthopedic Surgery and Sports Medical Center and Sports Medical Research Institute, Seoul Paik Hospital, College of Medicine, Inje University, Seoul, Korea.
Department of Orthopedic Surgery, Gangneung Asan Hospital, College of Medicine, Ulsan University, Gangneung, Korea.
Knee Surg Sports Traumatol Arthrosc. 2021 Dec;29(12):4122-4130. doi: 10.1007/s00167-020-06405-7. Epub 2021 Mar 17.
No studies have been conducted to determine long-term predictors of clinical failure after surgical root repair. This study identified long-term prognostic factors of clinical failure after pull-out repair of medial meniscus posterior root tears (MMPRTs) at a minimum of 10 year follow-up.
A total of 37 patients who underwent MMPRT pull-out repair and had been observed for more than 10 years were recruited for this study. The mean follow-up period was 125.9 ± 21.2 months. Clinical failure of the procedures was defined as conversion to total knee arthroplasty (TKA). Participants were categorized into two groups: non-failure and failure groups. Various factors, including demographic features and radiologic findings, were analyzed and compared between the two groups. Meniscus extrusion was assessed at coronal magnetic resonance imaging preoperatively and 1 year postoperatively. Independent risk factors were determined by univariate analysis and logistic regression analysis. To determine the cut-off value for risk factors, the receiver-operating characteristic curve analysis was performed.
In total, eight patients (22%) were converted to TKA during the follow-up period. With univariate analysis, statistically significant differences between two groups were observed in mechanical varus alignment (P = 0.018), rate of the number of patient with more meniscal extrusion values after surgery (P = 0.024), and the difference between the preoperative and 1-year postoperative value of meniscus extrusion (mm) (P = 0.010). In a logistic analysis, OR of mechanical varus alignment and differences in meniscus extrusion value before and 1 year after surgery was 1.5 (P = 0.048) and 3.7 (P = 0.034). The cut-off values of mechanical varus alignment and differences in meniscus extrusion values were 5 degrees and 0.7 mm.
Clinically, preoperative varus alignment and increased meniscal extrusion after surgery were found to be predictive for a clinical failure after meniscal root repair in a long-term perspective. Thus, these negative prognostic factors should be taken into consideration for performing root repair in MMPRTs.
Level III.
目前尚无研究确定半月板后根部撕裂（MPRT）经外科修复后的临床失败的长期预测因素。本研究旨在探讨经内侧半月板后根部撕裂（MMPRT）经皮抽出修复术后至少 10 年随访时临床失败的长期预后因素。
共纳入 37 例接受 MMPRT 经皮抽出修复术且随访时间超过 10 年的患者。平均随访时间为 125.9±21.2 个月。将手术过程中的临床失败定义为转为全膝关节置换术（TKA）。将参与者分为两组：非失败组和失败组。分析并比较两组之间的各种因素，包括人口统计学特征和影像学发现。术前和术后 1 年冠状位磁共振成像评估半月板挤出情况。采用单因素分析和逻辑回归分析确定独立危险因素。为确定危险因素的临界值，进行了受试者工作特征曲线分析。
在随访期间，共有 8 例患者（22%）转为 TKA。单因素分析显示，两组间机械性内翻对线（P=0.018）、术后有更多半月板挤出值的患者比例（P=0.024）和半月板挤出值术前与术后 1 年差值（mm）（P=0.010）差异均有统计学意义。逻辑回归分析显示，机械性内翻对线和半月板挤出值术前与术后 1 年差值的优势比（OR）分别为 1.5（P=0.048）和 3.7（P=0.034）。机械性内翻对线和半月板挤出值差值的临界值分别为 5 度和 0.7mm。
在临床实践中，术前内翻对线和术后半月板挤出增加被认为是 MMPRT 经半月板根部修复后长期临床失败的预测因素。因此，在进行 MMPRT 根部修复时，应考虑这些负面预后因素。
III 级。
