Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri.
J Bone Joint Surg Am. 2023 Jun 21;105(12):908-914. doi: 10.2106/JBJS.22.01196.
Meniscal repair is the goal, whenever possible, for the treatment of meniscal injury. The purpose of this study was to evaluate the long-term clinical success of meniscal repair performed with a second-generation, all-inside repair device with a concomitant anterior cruciate ligament (ACL) reconstruction.
This was a retrospective review of prospectively collected patients who underwent meniscal repair by a single surgeon using the all-inside FAST-FIX Meniscal Repair System (Smith & Nephew) in conjunction with a concurrent ACL reconstruction. Eighty-one meniscal repairs (81 patients) were identified: 59 medial repairs and 22 lateral repairs. Clinical failure was defined as repeat surgical intervention involving resection or revision repair. Clinical outcomes were assessed with the Knee injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee (IKDC) score, and Marx Activity Rating Scale score.
Ten-year follow-up was obtained for 85% (69) of 81 patients. Nine patients (13% of 69) underwent a failed meniscal repair (6 medial, 3 lateral), corresponding to a failure rate of 12% (6 of 50) for medial repairs and 16% (3 of 19) for lateral repairs. The mean time to failure was 2.8 years (range, 1.2 to 5.6 years) for the medial repairs and 5.8 years (range, 4.2 to 7.0 years) for the lateral repairs (p = 0.002). There was no difference in mean patient age, sex, body mass index, graft type, or number of sutures utilized between successful repairs and failures. Postoperative KOOS and IKDC outcome scores significantly improved over baseline scores (p < 0.001). There was no significant difference in patient-reported outcomes at 10 years between the group with successful repairs and those who had a failed repair.
This report of long-term follow-up results of primary second-generation, all-inside meniscal repair demonstrates its relative success when it is performed with concurrent ACL reconstruction. After a minimum follow-up of 10 years, 84% to 88% of the patients continued to demonstrate successful repair. Failure of medial meniscal repairs occurred significantly earlier compared with lateral meniscal repairs.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
半月板修复是治疗半月板损伤的目标，只要有可能。本研究的目的是评估使用第二代全内修复装置联合前交叉韧带（ACL）重建治疗半月板修复的长期临床效果。
这是一项对前瞻性收集的患者进行的回顾性研究，这些患者由一位外科医生使用全内 FAST-FIX 半月板修复系统（Smith & Nephew）进行半月板修复，并同时进行 ACL 重建。共确定 81 例半月板修复（81 例患者）：59 例内侧修复和 22 例外侧修复。临床失败定义为涉及切除或修正修复的重复手术干预。临床结果采用膝关节损伤和骨关节炎结果评分（KOOS）、国际膝关节文献委员会（IKDC）评分和 Marx 活动评分量表进行评估。
81 例患者中有 85%（69 例）获得了 10 年随访。9 例（69 例中的 13%）患者半月板修复失败（6 例内侧，3 例外侧），内侧修复失败率为 12%（6/50），外侧修复失败率为 16%（3/19）。内侧修复的平均失败时间为 2.8 年（范围，1.2 至 5.6 年），外侧修复的平均失败时间为 5.8 年（范围，4.2 至 7.0 年）（p = 0.002）。在成功修复和失败修复之间，患者的平均年龄、性别、体重指数、移植物类型或使用的缝线数量均无差异。术后 KOOS 和 IKDC 结果评分较基线评分显著提高（p < 0.001）。在 10 年时，成功修复组和失败修复组患者的患者报告结果无显著差异。
本报告对原发性第二代全内半月板修复的长期随访结果进行了报道，结果表明，当与 ACL 重建联合应用时，其具有相对的成功性。在至少 10 年的随访后，84%至 88%的患者继续表现出成功的修复。内侧半月板修复的失败发生时间明显早于外侧半月板修复。
治疗学 IV 级。有关证据水平的完整描述，请参见作者说明。
