Department of Orthopedics, the Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China.
Department of Orthopedics, Suqian First Hospital, Suqian, Jiangsu Province, China.
Medicine (Baltimore). 2022 Nov 11;101(45):e31760. doi: 10.1097/MD.0000000000031760.
In the present study, we aimed to investigate the clinical outcomes of arthroscopic discoid lateral meniscus (DLM) plasty and the adaptive changes in the patellofemoral joint after surgery. From September 2010 to March 2012, 25 patients with DLM injuries who underwent arthroscopic meniscus plasty were enrolled in the prospective study. All patients underwent clinical evaluation before the operation and at the last follow-up, and imaging evaluation was performed by upright magnetic resonance imaging before and 1 month after the operation as well as at the last follow-up. Clinical evaluation included Lysholm score, Kujala score, McMurray's sign, patellar mobility, patella grind test, and quadriceps atrophy. Imaging evaluation included bisect offset index, patella tilt angle (PTA), and cartilage damage. Lysholm score, Kujala score, McMurray's sign, and quadriceps atrophy at the last follow-up were significantly improved compared with the preoperative levels (P < .05). At the last follow-up, there were no statistical differences in patella mobility and patella grind test compared with the preoperative levels. In addition, bisect offset index and PTA showed a dynamic trend of rising and then falling over time (P < .05). At 1 month after the operation, bisect offset index and PTA were significantly increased compared with the preoperative levels or the values at the last follow-up (P < .05), while there were no differences between the preoperation and the last follow-up. Cartilage damage became worse with time (P < 0.05), and the 2 were positively correlated (Spearman = 0.368). At the last follow-up, the degree of cartilage damage was significantly increased compared with the preoperative level (P < .017), while there was no significant difference between the 1-month postoperative grade and the preoperational grade or the last follow-up grade. The effect of arthroscopic DLM plasty on the patellofemoral joint was dynamic, with the position of the patella deviating in the early stages and recovering in the mid-term, especially when the knee was in the biomechanical standing position. In addition, the patellofemoral joint cartilage might undergo accelerated degeneration after the operation, while the mid-term effect of the operation was positive, and the patellofemoral joint function was acceptable.
在本研究中，我们旨在探讨关节镜下盘状外侧半月板（DLM）成形术的临床疗效，以及术后髌股关节的适应性变化。2010 年 9 月至 2012 年 3 月，我们对 25 例接受关节镜半月板成形术的 DLM 损伤患者进行了前瞻性研究。所有患者均在术前及末次随访时进行临床评估，术前及术后 1 个月、末次随访时行直立位 MRI 影像学评估。临床评估包括 Lysholm 评分、Kujala 评分、McMurray 征、髌骨活动度、髌骨研磨试验和股四头肌萎缩。影像学评估包括二分髌骨指数、髌骨倾斜角（PTA）和软骨损伤。末次随访时 Lysholm 评分、Kujala 评分、McMurray 征和股四头肌萎缩较术前明显改善（P<.05）。末次随访时，髌骨活动度和髌骨研磨试验与术前相比无统计学差异。此外，二分髌骨指数和 PTA 随时间呈动态升高后下降的趋势（P<.05）。术后 1 个月，与术前或末次随访时相比，二分髌骨指数和 PTA 明显升高（P<.05），但与术前相比无差异。软骨损伤随时间进展而加重（P<.05），且两者呈正相关（Spearman=0.368）。末次随访时，软骨损伤程度较术前明显加重（P<.017），但术后 1 个月与术前或末次随访时相比无差异。关节镜 DLM 成形术对髌股关节的影响是动态的，髌骨位置在早期偏位，中期恢复，尤其是在膝关节生物力学站立位时。此外，术后髌股关节软骨可能发生加速退变，而手术中期效果为正性，髌股关节功能可接受。
