Department of Orthopedics, Affiliated Renhe Hospital of China Three Gorges University, Yichang, 443001, Hubei, China.
J Orthop Surg Res. 2022 Mar 18;17(1):170. doi: 10.1186/s13018-022-03045-0.
The indications and efficacy after arthroscopic partial meniscectomy (APM) for degenerative medial meniscus lesions (DMMLs) have been controversial. The purpose of this study was to identify predictors of unfavorable clinical and radiologic outcomes after APM for DMMLs and to choose appropriate indications and improve treatment efficacy.
A total of 86 patients with DMMLs undergoing APM were retrospectively reviewed. The mean follow-up time was 32.1 months. Clinical outcomes (including Lysholm score) and radiographic results (including Kellgren-Lawrence grade (K-L grade: 0/1/2/3/4) were evaluated at preoperative and final follow-up. Preoperative prognostic factors, including gender, age, Body Mass Index (BMI), Hip-Knee-Ankle (HKA), Medial Posterior Tibial Slope (MPTS), Medial Meniscus Extrusion (MME), K-L grade, occupational kneeling, and cartilaginous condition (Outerbridge grade ≤ 2, VS ≥ 3), for relatively unfavorable (fair or poor grade) Lysholm and progression of K-L grade, were investigated by multivariate logistic regression analysis. Receiver operating characteristic curve was used to identify a cutoff point for the extent of medial meniscal extrusion that was associated with the final Lysholm score.
A significantly improved postoperative Lysholm score (84.5 ± 9.7) compared with the preoperative score (63.8 ± 9.3) (P < 0.001), but a progression of K-L grade (20/36/30/0/0-15/27/25/19/0) (P < 0.001). The adverse prognostic factor of Lysholm score was the advancing age (OR 1.109, P = 0.05) and HKA (OR 0.255, P < 0.001). The adverse prognostic factor of K-L grade progression was MME (OR 10.327, P < 0.001). The cutoff point for the relative value of preoperative medial meniscal extrusion associated with relatively unfavorable Lysholm scores was 2.05 mm (Area = 0.8668, P value < 0.0001, Sensitivity = 62.16%, Specificity = 93.88%).
Clinically, varus alignment, large MME, and older age were found to predict a poor prognosis after APM for DMMLs. The preoperative extent of MME can be used as a predictive factor for osteoarthritis in APM. Patients with varus and MME should avoid APM. High tibial osteotomy may be an effective treatment strategy.
关节镜下部分半月板切除术（APM）治疗退行性内侧半月板病变（DMML）的适应证和疗效一直存在争议。本研究的目的是确定 DMML 行 APM 后临床和影像学结果不良的预测因素，并选择合适的适应证，提高治疗效果。
回顾性分析 86 例 DMML 行 APM 的患者。平均随访时间为 32.1 个月。术前和末次随访时评估临床结果（包括 Lysholm 评分）和影像学结果（包括 Kellgren-Lawrence 分级（K-L 分级：0/1/2/3/4）。采用多因素 logistic 回归分析探讨性别、年龄、体重指数（BMI）、髋膝踝角（HKA）、胫骨后内侧倾斜角（MPTS）、内侧半月板突出（MME）、K-L 分级、职业性跪位和软骨状况（Outerbridge 分级≤2，VS≥3）等术前预测因素与相对较差（差或极差）Lysholm 评分和 K-L 分级进展的关系。采用受试者工作特征曲线（ROC）确定与最终 Lysholm 评分相关的内侧半月板突出程度的截断点。
术后 Lysholm 评分（84.5±9.7）较术前（63.8±9.3）显著改善（P<0.001），但 K-L 分级进展（20/36/30/0/0-15/27/25/19/0）（P<0.001）。Lysholm 评分的不良预后因素是年龄增长（OR 1.109，P=0.05）和 HKA（OR 0.255，P<0.001）。K-L 分级进展的不良预后因素是 MME（OR 10.327，P<0.001）。与相对较差的 Lysholm 评分相关的术前内侧半月板突出的相对价值的截断点为 2.05mm（AUC=0.8668，P 值<0.0001，敏感性=62.16%，特异性=93.88%）。
临床研究发现，内翻畸形、较大的 MME 和年龄较大是 DMML 行 APM 后预后不良的预测因素。术前 MME 程度可作为 APM 后发生骨关节炎的预测因素。对于内翻和 MME 的患者，应避免 APM。高胫骨截骨术可能是一种有效的治疗策略。
