Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan.
Department of Orthopaedic Surgery, Osaka City General Hospital, Osaka, Japan.
Arch Orthop Trauma Surg. 2023 Aug;143(8):5157-5165. doi: 10.1007/s00402-022-04747-0. Epub 2023 Jan 3.
We compared subtotal meniscectomy and saucerization with stabilization for osteocartilaginous damage based on injured location and further examined the factors related to osteocartilaginous damage in juvenile discoid lateral meniscus (DLM) with peripheral tear after a follow-up period of at least 5 years.
We retrospectively reviewed juvenile DLM patients with peripheral tear who underwent arthroscopic surgery with more than 5 years of follow-up. Osteocartilaginous damage, which was identified by osteochondritis dissecans (OCD) development and the whole-organ magnetic resonance imaging score (WORMS) of cartilage grade ≥ 3, was compared between subtotal meniscectomy and saucerization with stabilization. A subgroup analysis examining the location of the tear site was performed. Factors for osteocartilaginous damage were analyzed between the damaged and non-damaged groups.
Forty-one patients, including 29 who underwent saucerization with stabilization and 12 who underwent subtotal meniscectomy, were included in this study. Seven patients developed OCD lesions; six patients showed cartilage WORMS of more than grade 3. Overall, there was a significant difference in the total cartilage and meniscus WORMS between the two groups at the final follow-up. The subgroup analysis demonstrated more severe osteocartilaginous damage developed in posterior subtotal meniscectomy than in posterior stabilization following saucerization. The damaged group showed significant difference compared to the non-damaged group in terms of age (p = 0.003), sex (p = 0.036), and posterior subtotal meniscectomy (p < 0.001).
Posterior subtotal meniscectomy revealed the worst scenario for the progression of osteocartilaginous damage in cases of juvenile DLM with peripheral tear over a minimum follow-up period of 5 years.
我们比较了基于损伤部位的半月板次全切除术和盘状半月板外侧后角成形术联合稳定术与单纯稳定术治疗青少年盘状外侧半月板（DLM）伴外周撕裂的骨软骨损伤，并进一步探讨了随访至少 5 年的青少年盘状外侧半月板伴外周撕裂患者骨软骨损伤的相关因素。
我们回顾性分析了行关节镜手术且随访时间超过 5 年的青少年 DLM 伴外周撕裂患者。根据软骨剥脱性骨软骨炎（OCD）的发生和软骨全器官 MRI 评分（WORMS）≥3，比较半月板次全切除术和盘状半月板外侧后角成形术联合稳定术治疗骨软骨损伤的效果。对撕裂部位进行亚组分析。分析骨软骨损伤组和无骨软骨损伤组的相关因素。
共纳入 41 例患者，其中 29 例行盘状半月板外侧后角成形术联合稳定术，12 例行半月板次全切除术。7 例患者出现 OCD 病变，6 例患者软骨 WORMS 评分大于 3 分。末次随访时，两组总软骨和半月板 WORMS 评分有显著差异。亚组分析显示，后角半月板次全切除术较后角盘状半月板成形术联合稳定术更易导致骨软骨损伤。与无骨软骨损伤组相比，损伤组的年龄（p=0.003）、性别（p=0.036）和后角半月板次全切除术（p<0.001）有显著差异。
对于青少年盘状外侧半月板伴外周撕裂患者，随访至少 5 年后，后角半月板次全切除术是导致骨软骨损伤进展最严重的情况。
