Cabral Joao, Sinikumpu Jaakko
Serviço de Ortopedia Pediátrica, Hospital Pediátrico-Centro Hospitalar e Universitário de Coimbra, EPE, Coimbra, Portugal.
Oulu University Hospital, Oulu, Finland.
J Child Orthop. 2023 Feb;17(1):63-69. doi: 10.1177/18632521231152270. Epub 2023 Feb 1.
The incidence of meniscal tears in children has been increasing. Early sport specialization, more intense training activity, and increasing participation in competitive sports may have affected to that increasing trend. Diagnosing acute menisci tear in children is based on suggestive clinical and magnetic resonance imaging findings. There are special particulars in immature menisci, due to relatively good vascular supply. Furthermore, growing skeleton makes differences in injury pattern, and a clinician needs to recognize not only meniscus but also potential injuries in growth plates and ligaments, which are usual in connection with pediatric meniscus leasion. Clinical and imaging investigation prior to treatment is crucial, because non-operative care is considerable, to achieve spontaneous healing, especially in peripherial tears of younger children. Second, repair is preferred always as possible, in spite of resection due to high rate of long-term sequelae after partial meniscectomy. High standard preoperative imaging aid in preparing to the meniscus sparing arthroscopic intervention.
In this current concept article, the clinical considerations of imaging the injured pediatric knee with a suspected meniscus tear and the treatment options by the imaging findings are reviewed.
level III.
儿童半月板撕裂的发生率一直在上升。早期专项运动、更剧烈的训练活动以及竞技体育参与度的增加可能影响了这一上升趋势。儿童急性半月板撕裂的诊断基于提示性的临床和磁共振成像结果。由于未成熟半月板的血供相对较好,所以存在一些特殊情况。此外,骨骼生长导致损伤模式有所不同,临床医生不仅需要识别半月板损伤,还需要认识到生长板和韧带的潜在损伤,这些损伤在儿童半月板损伤中很常见。治疗前的临床和影像学检查至关重要,因为非手术治疗是可行的,尤其是对于年幼儿童的周边撕裂,有望实现自愈。其次,尽管部分半月板切除术后长期后遗症发生率较高,但只要可能,总是优先选择修复。高标准的术前成像有助于准备保留半月板的关节镜干预。
在这篇当前的概念性文章中,回顾了对疑似半月板撕裂的受伤儿童膝关节进行成像的临床考虑因素以及根据成像结果的治疗选择。
三级。