North Sydney Orthopaedic and Sports Medicine Centre, Sydney, Australia.
North Sydney Orthopaedic and Sports Medicine Centre, Sydney, Australia; University of Notre Dame, School of Medicine, Sydney, Australia.
Arthroscopy. 2021 Dec;37(12):3500-3506. doi: 10.1016/j.arthro.2021.04.075. Epub 2021 May 13.
The purpose of this study was to compare long-term patient-reported outcomes in patients undergoing anterior cruciate ligament (ACL) reconstruction with untreated stable lateral meniscal posterior root (LMPR) tears to those with an intact meniscus.
Four hundred ninety-two subjects were followed for a minimum of 15-years post-ACL reconstruction and evaluated by an International Knee Documentation Committee questionnaire. The integrity of the meniscus was classified at surgery. Patients were grouped as either untreated injury to LMPR "with stable tear" (WST) group (n = 52) or intact lateral meniscus "no tear" (NT) group (n = 440). WST group included tears where those with a root avulsion within 9 mm of insertion and parrot beak tears with the integrity of the root attachment maintained. Outcomes were compared between groups.
ACL graft rupture occurred in 10% in the WST group and in 11% in the NT group (P = .78). For participants with an intact graft (n = 440), the mean International Knee Documentation Committee scores were 82, in the WST group, and 87, in the NT group (P = .03), with a small effect size of .32. The WST group had a worse mean pain severity score (P = .04) and higher frequency of pain (P = .03) than the NT group, but the effect size was small (P < 0.3). There was no difference in the overall knee function (P = .209) or International Knee Documentation Committee activity level (P = .882).
There was no adverse clinical outcome to leaving a stable LMPR tear in situ at the time of ACL reconstruction. LMPR tears left in situ were of minimal clinically significant long-term detriment, with outcomes similar to having an intact meniscus. There is an innate desire to fix the broken, but posterior meniscal root avulsions and stable parrot beak tears within 9 mm of insertion may not require intervention. At 15 years postinjury, most patients with a stable tear left in situ continue to enjoy an active lifestyle with a pain-free knee.
Level III, retrospective comparative study.
本研究旨在比较接受前交叉韧带（ACL）重建的患者中伴有未经治疗的稳定外侧半月板后根（LMPR）撕裂与半月板完整患者的长期患者报告结局。
492 例患者接受 ACL 重建后至少随访 15 年，并通过国际膝关节文献委员会（IKDC）问卷进行评估。在手术时对半月板的完整性进行分类。患者分为外侧半月板未撕裂的“无撕裂”（NT）组（n=440）和未治疗的 LMPR 损伤“伴有稳定撕裂”（WST）组（n=52）。WST 组包括半月板根部撕脱距离附着点 9mm 以内和鹦鹉嘴撕裂但根部附着完整的撕裂。比较两组之间的结果。
WST 组 10%的患者 ACL 移植物发生断裂，NT 组 11%的患者 ACL 移植物发生断裂（P=0.78）。对于移植物完整的患者（n=440），WST 组的 IKDC 平均评分为 82，NT 组为 87（P=0.03），效应量小，为 0.32。WST 组的平均疼痛严重程度评分（P=0.04）和疼痛频率（P=0.03）均较 NT 组差，但效应量较小（P<0.3）。两组的膝关节总体功能（P=0.209）和 IKDC 活动水平（P=0.882）无差异。
ACL 重建时不处理稳定的 LMPR 撕裂不会产生不良的临床结局。半月板后根撕脱和稳定的鹦鹉嘴撕裂在 9mm 以内，不处理不会造成明显的长期临床损害，与半月板完整的患者的结局相似。人们本能地希望修复受损的结构，但对于后半月板根部撕脱和稳定的鹦鹉嘴撕裂，若距离附着点 9mm 以内，则可能无需干预。在损伤后 15 年，大多数内侧半月板撕裂的患者继续享受无痛的活跃生活方式。
III 级，回顾性比较研究。
