撕裂的盘状外侧半月板会影响下肢对线，与年龄无关：无症状盘状外侧半月板不一定需要手术治疗。
A Torn Discoid Lateral Meniscus Impacts Lower-Limb Alignment Regardless of Age: Surgical Treatment May Not Be Appropriate for an Asymptomatic Discoid Lateral Meniscus.
机构信息
Center for Joint Surgery, Southwest Hospital (The First Affiliated Hospital of Army Medical University), Chongqing, People's Republic of China.
出版信息
J Bone Joint Surg Am. 2023 Jul 5;105(13):1020-1025. doi: 10.2106/JBJS.22.01314. Epub 2023 May 16.
BACKGROUND
A discoid lateral meniscus (DLM) is more prone to tear, and treatment of this condition is challenging. The purpose of the present study was to investigate (1) whether a torn DLM is associated with more varus alignment than a torn semilunar lateral meniscus (SLM) and (2) whether the lower-limb alignment associated with a torn DLM changes with age.
METHODS
Consecutive patients who underwent arthroscopic knee surgery for a torn lateral meniscus were included. Patients with a torn DLM (confirmed on arthroscopy) were allocated to the DLM group; those with a torn SLM were allocated to the SLM group. After strict screening according to the inclusion and exclusion criteria, 436 and 423 patients were included in the DLM and SLM groups, respectively. The mechanical axis deviation (MAD), hip-knee-ankle angle (HKA), mechanical lateral distal femoral angle, and medial proximal tibial angle were compared between the 2 groups after propensity score matching. Additionally, the correlation of the HKA and MAD with age was evaluated within the DLM group.
RESULTS
After propensity score matching, all baseline characteristics were well balanced between the 2 groups. The DLM group had significantly more varus alignment than the SLM group (MAD: 3.6 mm ± 9.6 mm versus 1.1 mm ± 10.3 mm, respectively, p = 0.001; HKA: 179.1° ± 2.9° versus 179.9° ± 3.0°, respectively, p = 0.001). Within the DLM group, the MAD (R = 0.10, p = 0.032) and HKA (R = -0.13, p = 0.007) had a weak correlation with age.
CONCLUSIONS
Patients with a torn DLM had more varus knee alignment than those with a torn SLM, and this trend did not increase with age after minimizing the effects of osteoarthritis. Therefore, surgical treatment may not be appropriate for asymptomatic DLM.
LEVEL OF EVIDENCE
Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.
背景
盘状外侧半月板（DLM）更易撕裂，且其治疗颇具挑战性。本研究旨在探究：（1）撕裂的 DLM 是否比撕裂的半月形外侧半月板（SLM）更易发生内翻畸形；（2）与撕裂的 DLM 相关的下肢对线是否会随年龄变化而改变。
方法
连续纳入因外侧半月板撕裂而行关节镜手术的患者。在关节镜下证实撕裂的 DLM 患者被分入 DLM 组，撕裂的 SLM 患者被分入 SLM 组。在严格根据纳入和排除标准进行筛选后，分别有 436 例和 423 例患者纳入 DLM 组和 SLM 组。对两组患者进行倾向评分匹配后，比较机械轴偏差（MAD）、髋膝踝角（HKA）、机械外侧股骨远端角和内侧胫骨近端角。此外，还评估了 DLM 组中 HKA 和 MAD 与年龄的相关性。
结果
经倾向评分匹配后，两组间的所有基线特征均均衡良好。与 SLM 组相比，DLM 组的内翻畸形更明显（MAD：3.6mm±9.6mm 比 1.1mm±10.3mm，p=0.001；HKA：179.1°±2.9°比 179.9°±3.0°，p=0.001）。在 DLM 组中，MAD（R=0.10，p=0.032）和 HKA（R=-0.13，p=0.007）与年龄呈弱相关。
结论
与撕裂的 SLM 相比，撕裂的 DLM 患者的膝关节内翻畸形更明显，且在最小化骨关节炎影响后，这种趋势不会随年龄增加而增加。因此，对于无症状的 DLM，手术治疗可能并不合适。
证据等级
预后 III 级。有关证据水平的完整描述，请参见《作者须知》。
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