Feroe Aliya G, Clark Sean C, Hevesi Mario, Okoroha Kelechi R, Saris Daniel B F, Krych Aaron J, Tagliero Adam J
Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
Curr Rev Musculoskelet Med. 2024 Aug;17(8):321-334. doi: 10.1007/s12178-024-09906-x. Epub 2024 Jun 1.
The purpose of this review is to summarize current clinical knowledge on the prevalence and types of meniscus pathology seen with concomitant anterior cruciate ligament (ACL) injury, as well as surgical techniques, clinical outcomes, and rehabilitation following operative management of these pathologies.
Meniscus pathology with concomitant ACL injury is relatively common, with reports of meniscus pathology identified in 21-64% of operative ACL injuries. These concomitant injuries have been associated with increased age and body mass index. Lateral meniscus pathology is more common in acute ACL injury, while medial meniscus pathology is more typical in chronic ACL deficiency. Meniscus tear patterns associated with concomitant ACL injury include meniscus root tears, lateral meniscus oblique radial tears of the posterior horn (14%), and ramp lesions of the medial meniscus (8-24%). These meniscal pathologies with concomitant ACL injury are associated with increased rotational laxity and meniscal extrusion. There is a paucity of comparative studies to determine the optimal meniscus repair technique, as well as rehabilitation protocol, depending on specific tear pattern, location, and ACL reconstruction technique. There has been a substantial increase in recent publications demonstrating the importance of meniscus repair at the time of ACL repair or reconstruction to restore knee biomechanics and reduce the risk of progressive osteoarthritic degeneration. Through these studies, there has been a growing understanding of the meniscus tear patterns commonly identified or nearly missed during ACL reconstruction. Surgical management of meniscal pathology with concomitant ACL injury implements the same principles as utilized in the setting of isolated meniscus repair alone: anatomic reduction, biologic preparation and augmentation, and circumferential compression. Advances in repair techniques have demonstrated promising clinical outcomes, and the ability to restore and preserve the meniscus in pathologies previously deemed irreparable. Further research to determine the optimal surgical technique for specific tear patterns, as well as rehabilitation protocols for meniscus pathology with concomitant ACL injury, is warranted.
本综述旨在总结当前关于前交叉韧带（ACL）损伤合并半月板病变的患病率和类型的临床知识，以及这些病变手术治疗后的手术技术、临床结果和康复情况。
ACL损伤合并半月板病变相对常见，据报道，在21%-64%的ACL手术损伤中发现有半月板病变。这些合并损伤与年龄增长和体重指数增加有关。外侧半月板病变在急性ACL损伤中更为常见，而内侧半月板病变在慢性ACL缺损中更为典型。与ACL损伤合并的半月板撕裂模式包括半月板根部撕裂、后角外侧半月板斜行放射状撕裂（14%）和内侧半月板斜坡损伤（8%-24%）。这些合并ACL损伤的半月板病变与旋转松弛增加和半月板挤压有关。目前缺乏比较研究来确定根据特定的撕裂模式、位置和ACL重建技术的最佳半月板修复技术以及康复方案。最近的出版物大量增加，表明在ACL修复或重建时进行半月板修复对于恢复膝关节生物力学和降低进行性骨关节炎退变风险的重要性。通过这些研究，人们对ACL重建过程中常见或几乎遗漏的半月板撕裂模式有了越来越多的了解。ACL损伤合并半月板病变的手术治疗遵循与单纯半月板修复相同的原则：解剖复位、生物准备和增强以及环向加压。修复技术的进步已显示出有前景 的临床结果，以及在以前被认为无法修复的病变中恢复和保留半月板的能力。有必要进一步研究确定针对特定撕裂模式的最佳手术技术，以及ACL损伤合并半月板病变的康复方案。
