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膝关节外侧半月板拉链样损伤：分类与修复方法

Lateral Meniscus Zip Lesion of Knee: Classification and Repair Methods.

作者信息

Gupta Sheetal, Dwivedi Ashutosh, Chavan Sachin K, Gupta Pakhi

机构信息

Galaxy Hospital, Bhopal (M.P.), India.

出版信息

Arthrosc Tech. 2024 Feb 1;13(4):102911. doi: 10.1016/j.eats.2024.102911. eCollection 2024 Apr.

DOI:10.1016/j.eats.2024.102911
PMID:38690337
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11056721/
Abstract

Lateral meniscus tears at the junction of the Wrisberg ligament and posterior horn are meniscocapsular injuries often seen with injury to the anterior cruciate ligament. Such lateral meniscus posterior horn lesions have been termed zip lesions. The lateral meniscus posterior horn is the major restraint for the pivot shift maneuver. Considering the morphology of condyles, lateral meniscus preservation and repair of unstable meniscocapsular posterior tear are needed to prevent future osteoarthritis. In this Technical Note, we aim to classify zip lesions of the posterior horn of the lateral meniscus. Zip lesions are located posteriorly and often are missed on magnetic resonance imaging and routine diagnostic arthroscopy. We recommend looking from the anteromedial portal and exploring the posterolateral compartment to identify hidden zip lesions, equivalent to medial-sided ramp lesions. We describe various all-inside techniques to repair these inaccessible tears.

摘要

在Wrisberg韧带与后角交界处的外侧半月板撕裂是半月板-关节囊损伤，常与前交叉韧带损伤同时出现。这种外侧半月板后角损伤被称为拉链样损伤。外侧半月板后角是轴移试验的主要限制因素。考虑到髁的形态，需要保留外侧半月板并修复不稳定的半月板-关节囊后撕裂，以预防未来的骨关节炎。在本技术说明中，我们旨在对外侧半月板后角的拉链样损伤进行分类。拉链样损伤位于后方，在磁共振成像和常规诊断性关节镜检查中常被漏诊。我们建议从前内侧入路观察并探查后外侧间隙，以识别隐藏的拉链样损伤，类似于内侧的斜坡样损伤。我们描述了各种全关节镜技术来修复这些难以触及的撕裂。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4f46/11056721/0df7685fbef7/gr11.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4f46/11056721/20ceb7854be1/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4f46/11056721/6ff0dc95bf42/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4f46/11056721/b525cecbd4cf/gr3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4f46/11056721/61991d5796de/gr4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4f46/11056721/53b4cc12ab7a/gr5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4f46/11056721/47ab5c42616d/gr6.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4f46/11056721/cde67a9b77df/gr7.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4f46/11056721/7605f29b3611/gr8.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4f46/11056721/4eb2ef966431/gr9.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4f46/11056721/cb024c60a78d/gr10.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4f46/11056721/0df7685fbef7/gr11.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4f46/11056721/20ceb7854be1/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4f46/11056721/6ff0dc95bf42/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4f46/11056721/b525cecbd4cf/gr3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4f46/11056721/61991d5796de/gr4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4f46/11056721/53b4cc12ab7a/gr5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4f46/11056721/47ab5c42616d/gr6.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4f46/11056721/cde67a9b77df/gr7.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4f46/11056721/7605f29b3611/gr8.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4f46/11056721/4eb2ef966431/gr9.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4f46/11056721/cb024c60a78d/gr10.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4f46/11056721/0df7685fbef7/gr11.jpg

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本文引用的文献

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Outside-in repair technique is effective in traumatic tears of the meniscus in active adults: a systematic review.外向修复技术在活跃成年人的半月板外伤性撕裂中有效：系统评价。
Knee Surg Sports Traumatol Arthrosc. 2023 Oct;31(10):4257-4264. doi: 10.1007/s00167-023-07475-z. Epub 2023 Jun 14.
2
All-Inside Meniscus Repair.全内半月板修复术
Curr Rev Musculoskelet Med. 2022 Aug;15(4):252-258. doi: 10.1007/s12178-022-09766-3. Epub 2022 Jun 4.
3
Inside-Out Approach to Meniscus Repair: Still the Gold Standard?半月板修复的由内而外技术：仍是金标准吗？
Curr Rev Musculoskelet Med. 2022 Aug;15(4):244-251. doi: 10.1007/s12178-022-09764-5. Epub 2022 Apr 30.
4
Meniscal ramp lesions: an illustrated review.半月板前角附着处损伤：图文综述
Insights Imaging. 2021 Sep 25;12(1):134. doi: 10.1186/s13244-021-01080-9.
5
Lateral Meniscus Height and ACL Reconstruction Failure: A Nested Case-Control Study.外侧半月板高度与 ACL 重建失败：巢式病例对照研究。
J Knee Surg. 2022 Aug;35(10):1138-1146. doi: 10.1055/s-0040-1722323. Epub 2021 Feb 22.
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Inside-out Repair of Extensive Meniscal Tears Using Posteromedial and Posterolateral Neurovascular Protective Windows.使用后内侧和后外侧神经血管保护窗对广泛半月板撕裂进行由内向外修复
Arthrosc Tech. 2021 Jan 20;10(1):e131-e138. doi: 10.1016/j.eats.2020.09.019. eCollection 2021 Jan.
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Small lateral meniscus tears propagate over time in ACL intact and deficient knees.小型半月板横向撕裂在 ACL 完整和缺失的膝关节中会随时间推移而扩散。
Knee Surg Sports Traumatol Arthrosc. 2021 Sep;29(9):3068-3076. doi: 10.1007/s00167-020-06356-z. Epub 2020 Nov 9.
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Alternative All-Inside Technique of Repairing a Vertical Meniscus Tear.修复垂直半月板撕裂的替代全内技术
Arthrosc Tech. 2020 Aug 7;9(8):e1181-e1189. doi: 10.1016/j.eats.2020.04.018. eCollection 2020 Aug.
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Arthrosc Tech. 2020 Jun 18;9(7):e979-e986. doi: 10.1016/j.eats.2020.03.016. eCollection 2020 Jul.
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