Shekhar Anshu, Tapasvi Sachin, Williams Andy
The Orthopaedic Speciality Clinic, Pune, India.
Fortius Clinic, London, UK.
Orthop J Sports Med. 2022 Mar 11;10(3):23259671221083318. doi: 10.1177/23259671221083318. eCollection 2022 Mar.
Lateral meniscus posterior root tears (LMPRTs) almost always occur in association with anterior cruciate ligament (ACL) tears. Their repair is advocated to restore the stabilizing and load-sharing functions of the meniscus.
To study the functional outcomes of combined arthroscopic repair of LMPRTs and ACL reconstruction (ACLR).
Case series; Level of evidence, 4.
The authors evaluated patients who underwent simultaneous arthroscopic ACLR and LMPRT repair. All patients had chronic injuries, with a mean time since ACL rupture of 7.9 months. Patient characteristics, Lachman and pivot-shift test results, type of LMPRT, associated injuries, and surgery details were documented. Pre- and postoperative functional status was assessed using the International Knee Documentation Committee (IKDC) score, Knee injury and Osteoarthritis Outcome Score (KOOS), and Lysholm score. An independent single-tunnel transtibial repair using 2 SutureTapes was performed for Forkel type 1 and 3 tear root avulsions, while side-to-side suture repair was performed for type 2 radial/oblique tears. The Wilcoxon signed rank test and minimal clinically important difference (MCID) of the IKDC score were used for statistical analysis.
Included were 25 patients with a mean age of 29.6 ± 6.5 years. Of these, 22 patients (88%; 95% CI, 73.1%-100%) had a high-grade (grade 2 or 3) preoperative pivot shift. Diagnosis of the LMPRT on magnetic resonance imaging (MRI) scans was possible only in 5 patients (20%). At final evaluation, performed at 37.4 ± 7.1 months postoperatively, all functional scores had improved significantly from preoperatively: IKDC score, from 47.6 ± 9.5 to 81.8 ± 11.5; KOOS, from 45.5 ± 10.9 to 86.5 ± 10.3, and Lysholm score, from 49.0 ± 11.5 to 88.8 ± 7.6 ( < .001 for all). Twenty-four patients (96%) achieved the MCID for the IKDC score. All knees had a negative pivot shift at final analysis, and no patient underwent revision ACLR or LMPRT repair.
LMPRT repair combined with ACLR led to good short-term clinical outcomes in this study. An LMPRT may frequently go undetected on preoperative MRI scans, but a high-grade pivot shift is present in a large majority of these patients.
外侧半月板后根部撕裂（LMPRTs）几乎总是与前交叉韧带（ACL）撕裂同时发生。提倡对其进行修复以恢复半月板的稳定和负荷分担功能。
研究关节镜下联合修复LMPRTs与ACL重建（ACLR）的功能结果。
病例系列；证据等级，4级。
作者评估了同时接受关节镜下ACLR和LMPRT修复的患者。所有患者均为慢性损伤，自ACL撕裂后的平均时间为7.9个月。记录患者特征、Lachman试验和轴移试验结果、LMPRT类型、相关损伤及手术细节。使用国际膝关节文献委员会（IKDC）评分、膝关节损伤和骨关节炎疗效评分（KOOS）以及Lysholm评分评估术前和术后的功能状态。对于Forkel 1型和3型撕裂根部撕脱，采用2根缝线带进行独立的单隧道经胫骨修复，而对于2型放射状/斜形撕裂则进行边对边缝合修复。采用Wilcoxon符号秩检验和IKDC评分的最小临床重要差异（MCID）进行统计分析。
纳入25例患者，平均年龄29.6±6.5岁。其中，22例患者（88%；95%CI，73.1%-100%）术前存在高级别（2级或3级）轴移。仅5例患者（20%）在磁共振成像（MRI）扫描中能够诊断出LMPRT。在术后37.4±7.1个月进行的最终评估中，所有功能评分均较术前显著改善：IKDC评分从47.6±9.5提高到81.8±11.5；KOOS评分从45.5±10.9提高到86.5±10.3，Lysholm评分从49.0±11.5提高到88.8±7.6（所有P均＜.001）。24例患者（96%）达到IKDC评分的MCID。最终分析时所有膝关节轴移均为阴性，且无患者接受ACLR或LMPRT修复翻修手术。
本研究中，LMPRT修复联合ACLR取得了良好的短期临床结果。术前MRI扫描可能经常无法检测到LMPRT，但这些患者中的大多数存在高级别轴移。
