Department of Orthopaedic Surgery, Chonnam National University Hwasun Hospital and Medical School, 322 Seoyang-ro, Hwasun-gun, Chonnam, 58218, Republic of Korea.
Department of Orthopaedic Surgery, Chonnam National University Hospital, 42 Jebongro, Donggu, Gwangju, 61469, Republic of Korea.
BMC Musculoskelet Disord. 2021 Aug 28;22(1):742. doi: 10.1186/s12891-021-04632-8.
The best treatment for degenerative medial meniscus posterior root tear (MMPRT) remains controversial. This study aimed to compare the clinical and radiological outcomes of arthroscopic meniscectomy and conservative treatment for degenerative MMPRT.
From January 2007 to December 2014, 146 patients (Meniscectomy group, 90; Conservative group, 56) were evaluated. Clinical outcomes were assessed using the Visual Analog Scale, International Knee Documentation Committee subjective scoring scale, Tegner activity scale, and Lysholm knee scoring scale at the final follow-up. Radiologic outcomes evaluated the progression of osteoarthritis (OA) according to the Kellgren-Lawrence (K-L) classification. We compared the hip-knee-ankle angle (HKAA), medial proximal tibial angle, tibial posterior slope angle, and width of medial joint space. After an average follow-up of 6.3 years, the survivorship was analyzed using the Kaplan-Meier method.
All clinical outcomes were significantly improved in both groups after treatment, with no significant differences between the two groups at the final follow-up. The progression of OA according to the K-L classification, HKAA and width of medial joint space was significantly advanced in the meniscectomy group (p = 0.03, 0.04, 0.03, respectively). The 10-year survival rates in the meniscectomy and conservative groups were 87 and 88%, respectively.
This study demonstrated that both conservative treatment and meniscectomy provided symptomatic relief. However, it was confirmed that OA progression was more severe in the meniscectomy. We conclude that arthroscopic meniscectomy had no advantage over conservative treatment in terms of clinical outcomes and OA progression in middle-aged patients with MMPRT.
Level III; retrospective comparative study.
退行性后内侧半月板根部撕裂（MMPRT）的最佳治疗方法仍存在争议。本研究旨在比较关节镜下半月板切除术和保守治疗退行性 MMPRT 的临床和影像学结果。
2007 年 1 月至 2014 年 12 月，共评估了 146 名患者（半月板切除术组，90 例；保守治疗组，56 例）。临床结果采用视觉模拟评分法、国际膝关节文献委员会主观评分、Tegner 活动量表和 Lysholm 膝关节评分在最终随访时进行评估。影像学结果根据 Kellgren-Lawrence（K-L）分类评估骨关节炎（OA）的进展。我们比较了髋膝踝角（HKAA）、胫骨近端内侧角、胫骨后倾角度和内侧关节间隙宽度。平均随访 6.3 年后，采用 Kaplan-Meier 法分析生存率。
两组治疗后所有临床结果均明显改善，最终随访时两组间无显著差异。根据 K-L 分类，半月板切除术组的 OA 进展、HKAA 和内侧关节间隙宽度明显进展（p=0.03、0.04、0.03，分别）。半月板切除术组和保守治疗组的 10 年生存率分别为 87%和 88%。
本研究表明，保守治疗和半月板切除术均可缓解症状。然而，证实半月板切除术组 OA 进展更为严重。我们得出结论，对于 MMPRT 的中年患者，关节镜下半月板切除术在临床结果和 OA 进展方面没有优于保守治疗的优势。
III 级；回顾性比较研究。
