Espejo-Reina Alejandro, Sevillano-Pérez Enrique, Espejo-Reina María Josefa, Lombardo-Torre Maximiano, Pérez-Blanca Ana, Espejo-Baena Alejandro
Clínica Espejo, Málaga, Spain.
Hospital Vithas Málaga, Málaga, Spain.
Arthrosc Sports Med Rehabil. 2023 Jul 31;5(5):100778. doi: 10.1016/j.asmr.2023.100778. eCollection 2023 Oct.
The purpose of this study was to evaluate practice patterns of a single surgeon with respect to meniscectomy and meniscal repair over a 20-year period at a single institution.
A cross-sectional descriptive study was carried out by reviewing the surgical data from the past 20 years (2002-2021) of patients who underwent arthroscopic primary meniscal surgery. Age, sex, knee and meniscus affected, morphology of the meniscal tear, meniscal radial location, location on the axial plane, tissue quality, and associated injuries were recorded. An analysis of the evolution of the characteristics of the meniscal lesions was performed according to the presence of degenerative tissue, the repairability of the lesion, and the treatment performed. Categorical data were represented in contingency tables and compared using the χ test for significance of differences, which was set at < .05.
In total, 1,892 cases were included. A decrease in degenerative meniscal tears was found, from 63.2 in 2002 to 2006 to 9.7% in 2017 to 2021 ( < .001), while repairable tears increased from 1.6% to 82.3% < .001); in the same periods, arthroscopic partial meniscectomy procedures declined from 75.7% to 17.7% ( < .001) while meniscal repair increased from 0.4% to 81.3% ( < .001). All types of tears increased significantly their repairability, although longitudinal tears, root tears, and ramp lesions showed the highest possibilities for repair.
In the present study, a drastic change in the attitude toward meniscal preservation in the past 20 years was observed, with a large increase in the proportion of tears considered repairable found in primary arthroscopic surgery (to 80% of cases) and a decrease in degenerative meniscus tears (to less than 10%).
In the past 2 decades, arthroscopic knee surgery has evolved such that more meniscus tears are deemed repairable, and fewer tears considered degenerative are indicated for arthroscopy.
本研究旨在评估一名外科医生在一家机构20年期间关于半月板切除术和半月板修复的手术模式。
通过回顾过去20年（2002 - 2021年）接受关节镜下初次半月板手术患者的手术数据进行横断面描述性研究。记录年龄、性别、受累膝关节和半月板、半月板撕裂的形态、半月板的径向位置、轴平面位置、组织质量和相关损伤。根据退变组织的存在、损伤的可修复性以及所进行的治疗，对半月板损伤特征的演变进行分析。分类数据以列联表表示，并使用χ检验比较差异的显著性，显著性水平设定为<0.05。
共纳入1892例病例。发现退变半月板撕裂有所减少，从2002年至2006年的63.2%降至2017年至2021年的9.7%（<0.001），而可修复撕裂从1.6%增加到82.3%（<0.001）；在同一时期，关节镜下部分半月板切除术从75.7%降至17.7%（<0.001），而半月板修复从0.4%增加到81.3%（<0.001）。所有类型的撕裂其可修复性均显著增加，尽管纵向撕裂、根部撕裂和斜坡损伤显示出最高的修复可能性。
在本研究中，观察到过去20年对半月板保留态度的剧烈变化，在初次关节镜手术中认为可修复的撕裂比例大幅增加（达病例的80%），退变半月板撕裂减少（至不到10%）。
在过去20年中，关节镜下膝关节手术已经发展，使得更多的半月板撕裂被认为可修复，而被认为退变的撕裂进行关节镜检查的情况减少。
