Suganuma Jun, Mochizuki Ryuta
Department of Orthopedic Surgery, Hiratsuka City Hospital, Hiratsuka, Japan.
Yamabiko Hiratsuka Clinic for Orthopedic and Rheumatic Disease, Hiratsuka, Japan.
Arthrosc Sports Med Rehabil. 2024 Mar 6;6(3):100922. doi: 10.1016/j.asmr.2024.100922. eCollection 2024 Jun.
To identify predictors of anterior mobility of the posterior horn of the lateral meniscus (PHLM) among patient demographics (age, sex), clinical characteristics (a history of catching or locking symptoms [CLS], body mass index, alignment of limb), and magnetic resonance imaging (MRI) findings of 4 restraints: anteroinferior popliteomeniscal fascicle (aiPMF), posterosuperior popliteomeniscal fascicle (psPMF), posteroinferior popliteomeniscal fascicle (piPMF), and meniscofibular ligament (MFibL).
Between October 2010 and December 2014, patients who underwent arthroscopic measurement of mobility of the PHLM were identified. The Sakai classification was used to classify aiPMF and psPMF on MRI into the following 3 types: type A, the fascicle was depicted with obvious continuity and with a low-intensity band; type B, depicted with continuity but with an ambiguous intensity structure; and type C, depicted with discontinuity or not visible. Magnetic resonance images of the piPMF and MFibL were evaluated as presence or absence. The mobility of the PHLM was measured arthroscopically at traction forces of 10 and 20 N.
A total of 73 patients (47 men, mean age 41.8 ± 19.3 years) were included. Multivariate regression analyses revealed aiPMF type C and psPMF types B and C to be independent factors associated with mobility at both traction forces, and CLS was an independent factor at a traction force of 20 N. Compared with that of type A, the increased mobility of aiPMF type C was 5.0 mm ( = .019) and 5.6 mm ( = .011) at 10 and 20 N, respectively; the increased mobility of psPMF type B was 2.5 mm ( = .007) and 3.5 mm ( = .0003), respectively; and the increased mobility of psPMF type C was 3.3 mm ( = .021) and 3.6 mm ( = .014), respectively. The increased mobility associated with CLS was 3.5 mm at 20 N ( = .022).
Anterior displacement of the PHLM induced by an external traction force at 90° of flexion of the knee joint was associated with abnormal MRI findings of the anteroinferior popliteomeniscal fascicle and posterosuperior popliteomeniscal fascicle, as well as a history of catching or locking symptoms.
Understanding signs and symptoms and associated pathology in patients with symptomatic anterior mobility of the posterior horn of the lateral meniscus may help guide best treatment.
在患者人口统计学特征（年龄、性别）、临床特征（卡顿或绞锁症状史[CLS]、体重指数、肢体对线情况）以及磁共振成像（MRI）显示的4种限制结构（前下腘半月板束[aiPMF]、后上腘半月板束[psPMF]、后下腘半月板束[piPMF]和半月板股骨韧带[MFibL]）中，确定外侧半月板后角（PHLM）前向移动的预测因素。
2010年10月至2014年12月期间，纳入接受了关节镜下测量PHLM移动性的患者。采用Sakai分类法将MRI上的aiPMF和psPMF分为以下3种类型：A型，束状结构连续性明显且有低强度带；B型，有连续性但强度结构不明确；C型，连续性中断或不可见。对piPMF和MFibL的MRI图像评估其有无。在10 N和20 N的牵引力下，通过关节镜测量PHLM的移动性。
共纳入73例患者（47例男性，平均年龄41.8±岁）。多因素回归分析显示，aiPMF C型以及psPMF B型和C型是在两种牵引力下与移动性相关的独立因素，而CLS是在20 N牵引力下的独立因素。与A型相比，aiPMF C型在10 N和20 N时移动性增加分别为毫米（P = 0.019）和5.6毫米（P = 0.011）；psPMF B型移动性增加分别为2.5毫米（P = 0.007）和3.5毫米（P = 0.0003）；psPMF C型移动性增加分别为3.3毫米（P = 0.021）和3.6毫米（P = 0.014）。与CLS相关的移动性增加在20 N时为3.5毫米（P = 0.022）。
膝关节屈曲90°时，外部牵引力引起的PHLM前向移位与前下腘半月板束和后上腘半月板束的MRI异常表现以及卡顿或绞锁症状史相关。
了解外侧半月板后角有症状性前向移动患者中的体征、症状及相关病理情况，可能有助于指导最佳治疗。
