Yáñez-Diaz Roberto, Strömbäck Lars, Vergara Francisco, Caracciolo Gaston, Saravia Anthony, Sandoval Carlos, Zamorano Héctor, Abusleme Sebastián, De la Fuente Carlos
Traumatologia, Clínica MEDS, Santiago, Chile.
Centro de Innovación, Clínica MEDS, Santiago, Chile.
Adv Orthop. 2022 Jan 29;2022:1766401. doi: 10.1155/2022/1766401. eCollection 2022.
Traditional techniques can enlarge the medial tibiofemoral joint space width (JSW) for meniscal repairs, but a remnant ligament laxity may be developed. Alternatively, the debridement of the inner retinaculum layer may result in a balanced JSW without causing extra-ligament damage (retinaculum layers II and collateral ligament).
The purpose of this study was to determine whether a concentric arthroscopic debridement of the inner retinaculum layer increases the tibiofemoral JSW in patients with meniscal injuries. Secondarily, we determine whether the increase in JSW is symmetrical between compartments and describe the rate of complications and patient satisfaction.
Twenty middle-aged (15 male and five female) patients diagnosed with acute meniscal injury aged 36 ± 12 years were enrolled. The patients were submitted to an arthroscopic debridement of the inner layer of the knee retinaculum for both the medial and lateral compartments. The tibiofemoral JSW was measured intra-articularly using a custom instrument. A two-way ANOVA for repeated measures was used to compare the JSW. A Bland-Altman analysis and test-retest analysis were performed.
The JSW increased following the debridement of the inner retinaculum layer, for both the medial and lateral compartments ( < 0.001). No complications were identified, and the patients were satisfied with the intervention. The minimal detectable change and bias of the custom instrument were 0.06 mm and 0.02 mm, respectively.
The debridement allows a clinically important (>1 mm) symmetric tibiofemoral JSW enlargement. The technique suggests favoring the diagnosis of meniscus injuries and manipulating arthroscopic instruments without secondary complications after one year.
传统技术可扩大胫股内侧关节间隙宽度（JSW）以进行半月板修复，但可能会导致残余韧带松弛。另外，对内侧支持带内层进行清创术可能会使关节间隙宽度达到平衡，且不会造成额外的韧带损伤（支持带层II和侧副韧带）。
本研究的目的是确定对内侧支持带内层进行同心关节镜清创术是否会增加半月板损伤患者的胫股关节间隙宽度。其次，我们确定关节间隙宽度的增加在各间室之间是否对称，并描述并发症发生率和患者满意度。
纳入20例年龄在36±12岁的诊断为急性半月板损伤的中年患者（15例男性和5例女性）。对患者的膝关节内侧和外侧间室的支持带内层进行关节镜清创术。使用定制器械在关节内测量胫股关节间隙宽度。采用重复测量的双向方差分析来比较关节间隙宽度。进行了Bland-Altman分析和重测分析。
内侧支持带内层清创术后，内侧和外侧间室的关节间隙宽度均增加（<0.001）。未发现并发症，患者对干预措施满意。定制器械的最小可检测变化和偏差分别为0.06毫米和0.02毫米。
清创术可使胫股关节间隙宽度在临床上实现重要的（>1毫米）对称性扩大。该技术有利于半月板损伤的诊断，并在一年后操作关节镜器械时不会产生继发并发症。
