半月板桶柄状撕裂修复术后良好的中长期疗效：前交叉韧带重建与未重建的对比分析
Good mid- to long-term outcomes after meniscus bucket-handle tear repair: A comparative analysis with and without anterior cruciate ligament reconstruction.
作者信息
Pawelczyk Johannes, Fanourgiakis Ilias, Feil Sven, Siebold Maja, Kougioumtzis Ioannis, Siebold Rainer
机构信息
International Center for Orthopedics, ATOS Clinic Heidelberg Germany.
Ruprecht Karl University Heidelberg Germany.
出版信息
J Exp Orthop. 2024 Jul 15;11(3):e12093. doi: 10.1002/jeo2.12093. eCollection 2024 Jul.
PURPOSE
To evaluate mid- to long-term clinical outcomes after arthroscopic bucket-handle meniscal tear (BHMT) repair and to assess the impact of concurrent anterior cruciate ligament reconstruction (ACLR).
METHODS
A comparative retrospective case series with blinded outcome assessment was conducted. All consecutive patients treated with arthroscopic BHMT repair with or without concurrent ACLR between 2001 and 2021 were eligible for inclusion. Fifty-five patients with an average follow-up of 7.3 ± 3.4 years were included in the analysis. Outcome measures comprised post-operative IKDC Subjective Knee Form, Lysholm Score, Tegner Activity Scale, KOOS, and visual analogue scale (VAS) for satisfaction. Additionally, failure and reoperation rates were assessed.
RESULTS
The failure rate was 9%. Medial BHMT repair showed superior post-operative IKDC scores compared to lateral meniscus repair ( = 0.038). Concurrent ACLR did not demonstrate any impact on post-operative KOOS, IKDC, Tegner or patient satisfaction. The mean IKDC score at final follow-up across both groups was 80.4 ± 17.8. The mean Lysholm score was 86.9 ± 16.7. Mean KOOS scores were (i) symptoms: 83.6 ± 18.3, (ii) pain: 90.2 ± 14.4, (iii) activities of daily living: 93.6 ± 15.1, (iv) sports: 78.3 ± 26.0 and (v) quality of life: 70.5 ± 24.5. Mean patient satisfaction (VAS) was 7.9 ± 2.5. The mean Tegner score was 4.9 ± 1.9. A consistent positive correlation between the number of sutures used and post-operative outcome measures was observed but did not reach statistical significance for most items.
CONCLUSION
Arthroscopic BHMT repair achieved good clinical outcomes and an acceptable failure rate of 9% at a mean follow-up of 7 years, supporting the clinical value of meniscal repair, including large BHMTs. Concurrent ACLR showed no impact on clinical outcomes.
LEVEL OF EVIDENCE
Level IV (retrospective case series).
目的
评估关节镜下半月板桶柄状撕裂（BHMT）修复术后的中长期临床疗效，并评估同期前交叉韧带重建（ACLR）的影响。
方法
进行一项带有盲法结局评估的比较性回顾性病例系列研究。纳入2001年至2021年间所有接受关节镜下BHMT修复术（无论是否同期进行ACLR）的连续患者。分析纳入了55例患者，平均随访时间为7.3±3.4年。结局指标包括术后IKDC主观膝关节评分表、Lysholm评分、Tegner活动量表、KOOS以及满意度视觉模拟量表（VAS）。此外，评估失败率和再次手术率。
结果
失败率为9%。内侧BHMT修复术后的IKDC评分高于外侧半月板修复（=0.038）。同期ACLR对术后KOOS、IKDC、Tegner评分或患者满意度均无影响。两组最终随访时的平均IKDC评分为80.4±17.8。平均Lysholm评分为86.9±16.7。KOOS平均评分如下：（i）症状：83.6±18.3，（ii）疼痛：90.2±14.4，（iii）日常生活活动：93.6±15.1，（iv）运动：78.3±26.0，（v）生活质量：70.5±24.5。患者平均满意度（VAS）为7.9±2.5。平均Tegner评分为4.9±1.9。观察到使用的缝线数量与术后结局指标之间存在一致的正相关，但大多数项目未达到统计学意义。
结论
关节镜下BHMT修复术取得了良好的临床疗效，平均随访7年时失败率为9%可接受，这支持了半月板修复（包括大型BHMT）的临床价值。同期ACLR对临床疗效无影响。
证据水平
IV级（回顾性病例系列）。
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