Nishino Kazuya, Hashimoto Yusuke, Iida Ken, Nishida Yohei, Yamasaki Shinya, Nakamura Hiroaki
Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.
Department of Orthopaedic Surgery, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan.
Orthop J Sports Med. 2022 May 4;10(5):23259671221091997. doi: 10.1177/23259671221091997. eCollection 2022 May.
BACKGROUND: Although arthroscopic reshaping surgery for a discoid lateral meniscus (DLM) has good clinical results, it cannot completely prevent degeneration. The degree of DLM extrusion associated with degenerative changes is unclear. PURPOSE/HYPOTHESIS: To measure meniscal extrusion preoperatively and postoperatively in patients who underwent DLM-reshaping surgery and examine factors associated with knee articular cartilage degeneration. It was hypothesized that meniscal extrusion existed preoperatively, progressed postoperatively, and was related to knee joint degeneration. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: We retrospectively reviewed the medical records of patients who underwent DLM-reshaping surgery and attended ≥2 years of follow-up. Magnetic resonance imaging (MRI) was performed preoperatively and at 24 months postoperatively, and residual midbody meniscal extrusion was measured. Cartilage degeneration was detected when the Whole-Organ Magnetic Resonance Imaging Score (WORMS) of the lateral compartment was grade ≥3 at 2 years postoperatively. Factors associated with MRI cartilage degeneration were evaluated. RESULTS: Included in this study were 48 knees in 39 patients; the mean patient age at the time of surgery was 12.0 years. The mean midbody meniscal extrusion significantly increased from 0.8 mm preoperatively to 1.6 mm at 24 months postoperatively ( < .001). According to the WORMS cartilage score, 16 patients were categorized as having MRI cartilage degeneration. Multivariate logistic analysis showed that an inferior preoperative Lysholm score (odds ratio, 0.89; = .024) and postoperative extrusion (odds ratio, 6.18; = .010) significantly increased the risk of cartilage degeneration. The receiver operating characteristic curve showed that a residual meniscal extrusion of 2.0 mm was the cutoff value indicating cartilage degeneration (sensitivity, 87.5%; specificity, 78.1%). CONCLUSION: DLM extrusion significantly increased from 0.8 mm preoperatively to 1.6 mm at 2 years postoperatively. Postoperative extrusion and a lower preoperative Lysholm score were factors related to MRI cartilage degeneration postoperatively. A postoperative extrusion of 2.0 mm was the cutoff value for MRI cartilage degeneration.
背景：尽管盘状外侧半月板（DLM）的关节镜整形手术具有良好的临床效果，但它不能完全防止退变。与退变改变相关的DLM挤出程度尚不清楚。 目的/假设：测量接受DLM整形手术患者术前和术后的半月板挤出情况，并检查与膝关节软骨退变相关的因素。假设术前存在半月板挤出，术后进展，且与膝关节退变有关。 研究设计：病例对照研究；证据等级，3级。 方法：我们回顾性分析了接受DLM整形手术并进行了≥2年随访的患者的病历。术前和术后24个月进行磁共振成像（MRI）检查，并测量半月板体部的残余挤出情况。术后2年外侧间室的全器官磁共振成像评分（WORMS）≥3级时检测软骨退变。评估与MRI软骨退变相关的因素。 结果：本研究纳入39例患者的48个膝关节；手术时患者的平均年龄为12.0岁。半月板体部的平均挤出量从术前的0.8 mm显著增加到术后24个月的1.6 mm（P <.001）。根据WORMS软骨评分，16例患者被归类为MRI软骨退变。多因素逻辑分析显示，术前Lysholm评分较低（比值比，0.89；P =.024）和术后挤出（比值比，6.18；P =.010）显著增加了软骨退变的风险。受试者工作特征曲线显示，半月板残余挤出量为2.0 mm是表明软骨退变的临界值（敏感性，87.5%；特异性，78.1%）。 结论：DLM挤出量从术前的0.8 mm显著增加到术后2年的1.6 mm。术后挤出和术前较低的Lysholm评分是术后与MRI软骨退变相关的因素。术后挤出量2.0 mm是MRI软骨退变的临界值。
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