Wu He, Dai Zhu, Chen Yuxi, Fan Weijie, Liao Ying, Liu Chao, Liu Jianghua, Ming Yu
Specialty of Sports Medicine in Department of Orthopedics, the First Affiliated Hospital, University of South China, Hengyang Hunan, 421001, P. R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2024 Mar 15;38(3):272-277. doi: 10.7507/1002-1892.202312007.
To discuss the application of anterior region suture of the popliteal hiatus (PH) under arthroscopy in the treatment of discoid lateral meniscus (DLM) injury with instability in the popliteal tendon region.
The clinical data of 53 patients (56 knees) with DLM injury who met the selection criteria between March 2014 and November 2022 were retrospectively analyzed. There were 15 males and 38 females, aged 8-55 years with an average age of 36.5 years. Fourteen cases had a history of trauma, while the remaining 39 cases had no clear history of trauma. The disease duration ranged from 1 day to 6 years, with an average duration of 15.6 months. According to the Watanabe classification, there were 40 knees of complete type and 16 knees of incomplete type. The preoperative International Knee Documentation Committee (IKDC) knee joint score was 51.2±8.3, the Lysholm score was 59.6±11.2, and the visual analogue scale (VAS) score was 4.7±1.3. After the arthroscopic meniscal plasty, the instability of the popliteal tendon region meniscus was checked by probing traction. Subsequently, the Out-inside technique or a combination of Out-inside and All-inside techniques was used to suture the anterior region of the PH. The stability of the meniscus after suturing was assessed, and if necessary, further suturing using the All-inside technique at the posterior region of the PH, the posterior horn of the meniscus, and using the Out-inside technique at the anterior horn of the meniscus was performed. Postoperative complications were recorded. The effectiveness was evaluated using pre- and post-operative IKDC scores, Lysholm scores, and VAS scores.
After operation, knee joint pain, crepitus, and locking disappeared, with McMurray and grinding tests turning negative. All patients were followed up 12-93 months with an average of 57.5 months. There was no complication such as common peroneal nerve injury, deep vein thrombosis of the lower limbs, joint infection, or joint stiffness. At last follow-up, the IKDC knee joint score was 76.7±5.5, the Lysholm score was 94.0±4.1, and the VAS score was 1.1±0.8. The differences compared with preoperative scores were significant ( =-22.090, <0.001; =-23.704, <0.001; =19.767, <0.001).
Suturing of the anterior region of the PH is crucial in the treatment of DLM injury with instability in the popliteal tendon region.
探讨关节镜下腘肌腱裂孔（PH）前区缝合在治疗腘肌腱区域不稳定的盘状外侧半月板（DLM）损伤中的应用。
回顾性分析2014年3月至2022年11月间符合入选标准的53例（56膝）DLM损伤患者的临床资料。其中男性15例，女性38例，年龄8 - 55岁，平均年龄36.5岁。14例有外伤史，其余39例无明确外伤史。病程1天至6年，平均病程15.6个月。根据渡边分类，完全型40膝，不完全型16膝。术前国际膝关节文献委员会（IKDC）膝关节评分为51.2±8.3，Lysholm评分为59.6±11.2，视觉模拟评分（VAS）为4.7±1.3。关节镜下半月板成形术后，通过探查牵引检查腘肌腱区域半月板的稳定性。随后，采用外向内技术或外向内与全内技术相结合的方法缝合PH的前区。评估缝合后半月板的稳定性，必要时在PH后区、半月板后角采用全内技术进一步缝合，在半月板前角采用外向内技术进行缝合。记录术后并发症。采用术前和术后的IKDC评分、Lysholm评分和VAS评分评估疗效。
术后膝关节疼痛、弹响和交锁消失，McMurray试验和研磨试验转阴。所有患者均获随访12 - 93个月，平均57.5个月。未出现腓总神经损伤、下肢深静脉血栓形成、关节感染或关节僵硬等并发症。末次随访时，IKDC膝关节评分为76.7±5.5，Lysholm评分为94.0±4.1，VAS评分为1.1±0.8。与术前评分比较差异有统计学意义（=-22.090，<0.001；=-23.704，<0.001；=19.767，<0.001）。
PH前区缝合在治疗腘肌腱区域不稳定的DLM损伤中至关重要。
