关节镜下膝关节软骨下不全骨折的高转换率导致关节置换术。
Post-arthroscopic Subchondral Insufficiency Fractures of the Knee Yield High Rate of Conversion to Arthroplasty.
机构信息
Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, U.S.A.
Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, U.S.A..
出版信息
Arthroscopy. 2021 Aug;37(8):2545-2553. doi: 10.1016/j.arthro.2021.03.029. Epub 2021 Mar 25.
PURPOSE
To evaluate both the potential causes and resultant outcomes in patients in whom subchondral insufficiency fracture of the knee (SIFK) develops after arthroscopy.
METHODS
We performed a retrospective review of all patients with a magnetic resonance imaging diagnosis of SIFK after arthroscopic meniscectomy and chondroplasty over a 12-year period.
RESULTS
A total of 28 patients were included, with a mean age of 61 years and mean follow-up period of 5.7 years. SIFK showed a predilection for the medial compartment (n = 25, 89%), specifically the medial femoral condyle (n = 21, 75%). In 7 patients (25%), SIFK developed in both the femoral condyle and tibial plateau in the ipsilateral compartment. Fifteen patients (54%) went on to conversion to arthroplasty at a mean of 0.72 years. The rate of survival free of conversion to arthroplasty was 57%, 45%, and 40% at 1 year, 2 years, and 5 years, respectively. Furthermore, 63% of patients with a meniscal tear and SIFK in the same compartment went on to arthroplasty (P = .04). There was an increased risk of conversion to arthroplasty if SIFK was present in both the femur and tibia in the same compartment (P = .04). A higher Kellgren-Lawrence grade at the time of the SIFK diagnosis increased the likelihood of eventual arthroplasty (P = .03). The presence of SIFK in both the femur and tibia in the ipsilateral compartment, an increased Kellgren-Lawrence grade, and a meniscal tear or prior meniscectomy in the same compartment as SIFK were associated with an increased risk of eventual arthroplasty.
CONCLUSIONS
Post-arthroscopic SIFK most commonly occurs in the medial compartment, particularly in patients who underwent a prior meniscectomy. The presence of meniscal root and radial tears in these patients is notable (75%). Ultimately, there is a high rate of progression of arthrosis (33%) and eventual conversion to arthroplasty.
LEVEL OF EVIDENCE
Level IV, case series.
目的
评估膝关节软骨下不全骨折（SIFK）在关节镜检查后发生的潜在原因和结果。
方法
我们对 12 年来所有接受关节镜半月板切除术和软骨成形术后磁共振成像诊断为 SIFK 的患者进行了回顾性分析。
结果
共纳入 28 例患者，平均年龄 61 岁，平均随访时间 5.7 年。SIFK 主要发生在膝关节内侧（n=25，89%），特别是股骨内侧髁（n=21，75%）。7 例（25%）患者同侧膝关节股骨髁和胫骨平台均出现 SIFK。15 例（54%）患者平均在 0.72 年内转为关节置换术。1 年、2 年和 5 年时无关节置换术生存率分别为 57%、45%和 40%。此外，同一部位半月板撕裂合并 SIFK 的患者中，有 63%转为关节置换术（P=0.04）。同一部位 SIFK 同时存在于股骨和胫骨时，转为关节置换术的风险增加（P=0.04）。SIFK 诊断时的 Kellgren-Lawrence 分级较高，最终行关节置换术的可能性增加（P=0.03）。同一部位 SIFK 同时存在于股骨和胫骨、Kellgren-Lawrence 分级较高以及同一部位半月板撕裂或既往半月板切除术与最终行关节置换术相关。
结论
关节镜检查后 SIFK 最常发生在膝关节内侧，特别是在既往行半月板切除术的患者中。这些患者的半月板根部和放射状撕裂很常见（75%）。最终，骨关节炎进展率较高（33%），最终转为关节置换术。
证据等级
IV 级，病例系列研究。
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