Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
Am J Sports Med. 2023 Aug;51(10):2603-2607. doi: 10.1177/03635465231185132. Epub 2023 Jul 12.
Medial meniscus posterior root tears (MMPRTs) cause pain and dysfunction and are associated with poor clinical outcomes with nonoperative management at short-term follow-up. However, little is known about the long-term natural history of these tears.
The purpose of this study was to (1) provide an update to a previous minimum 2-year study on the natural progression of these tears and (2) evaluate long-term patient-reported and radiographic outcomes.
Case series (prognosis); Level of evidence, 4.
A retrospective review was performed on a cohort of patients with untreated MMPRTs, diagnosed between 2005 and 2013, who were followed clinically using International Knee Documentation Committee (IKDC), visual analog scale for pain, and Tegner activity scores as well as radiographically at a minimum 10-year follow-up. Failure was defined as conversion to arthroplasty or a severely abnormal subjective IKDC score <75.4.
Overall, 5 (10%) of the original 52 patients with minimum 2-year outcomes were subsequently lost to follow-up. The remaining 47 patients (21 male, 26 female) were followed for a mean of 14 ± 2 years (range, 11-18 years). At final follow-up, 25 patients (53%) had progressed to total knee arthroplasty, 8 (17%) were deceased, and 14 (30%) had not progressed to total knee arthroplasty. The mean IKDC and Tegner activity scores for the 14 patients with remaining MMPRTs were 51.6 ± 22.2 and 3.1 ± 1.1, respectively, and the mean visual analog scale score was 4.4 ± 3.0. Radiographically, the mean Kellgren-Lawrence grade progressed from 1.2 ± 0.7 at baseline to 2.6 ± 0.5 at final follow-up ( < .001). At a minimum 10-year follow-up, 37 of 39 living patients (95%) had failed nonoperative treatment.
Poor clinical and radiographic outcomes were associated with the nonoperative treatment of degenerative MMPRTs at long-term follow-up. This study provides a valuable update on the natural history and long-term prognosis of nonoperatively treated MMPRTs.
内侧半月板后根撕裂（MMPRT）会引起疼痛和功能障碍，并且与非手术治疗的短期随访结果不佳有关。然而，对于这些撕裂的长期自然病史知之甚少。
本研究的目的是（1）对之前一项关于这些撕裂自然进展的至少 2 年研究进行更新，（2）评估长期的患者报告和影像学结果。
病例系列（预后）；证据水平，4 级。
对 2005 年至 2013 年间诊断为未经治疗的 MMPRT 的患者队列进行回顾性研究，通过国际膝关节文献委员会（IKDC）、疼痛视觉模拟评分和 Tegner 活动评分进行临床随访，并在至少 10 年的随访时进行影像学随访。失败定义为转换为关节置换或严重异常的主观 IKDC 评分<75.4。
总体而言，在最初具有至少 2 年结果的 52 名患者中，有 5 名（10%）患者随后失访。其余 47 名患者（21 名男性，26 名女性）平均随访 14±2 年（范围，11-18 年）。最终随访时，25 名患者（53%）进展为全膝关节置换术，8 名（17%）患者死亡，14 名（30%）患者未进展为全膝关节置换术。14 名仍有 MMPRT 的患者的平均 IKDC 和 Tegner 活动评分分别为 51.6±22.2 和 3.1±1.1，平均视觉模拟评分（VAS）为 4.4±3.0。影像学上，平均 Kellgren-Lawrence 分级从基线时的 1.2±0.7 进展到最终随访时的 2.6±0.5（<0.001）。在至少 10 年的随访中，39 名存活患者中有 37 名（95%）非手术治疗失败。
退行性 MMPRT 非手术治疗的长期随访结果较差，与较差的临床和影像学结果相关。本研究提供了有关非手术治疗 MMPRT 的自然病史和长期预后的宝贵更新。
