Petersen Wolf, Mustafa Hassan Al, Fricke Leo Vincent, Braun Karl, Häner Martin
Klinik für Orthopädie und Unfallchirurgie, Martin-Luther-Krankenhaus Berlin, Caspar Theyß-Str. 27-31, 14193, Berlin, Deutschland.
Oper Orthop Traumatol. 2024 Aug 22. doi: 10.1007/s00064-024-00858-6.
Refixation of a posterior root lesion of the medial meniscus via a tibial drill tunnel and prevention of extrusion using a meniscotibial suture (centralization).
Posterior root lesion of the medial meniscus.
Grade 4 cartilage damage in the corresponding compartment, uncorrected varus or valgus deformities, symptomatic instabilities, extensive degenerative tears apart from the root region.
Knee arthroscopy via the high anterolateral standard portal. Diagnostic arthroscopy to check indication. Locate the insertion zone on the tibial plateau and local debridement until the bone of the tibial plateau is visible. Insertion of a targeting device and drilling of a targeting wire into the center of the insertion zone in the area of the intercondylar eminence. Overdrill the target wire with a 4.5 mm drill. Reinforcement of the medial meniscus posterior horn with braided suture material. The reinforcing thread is inserted into the bone tunnel via an eyelet wire with a thread loop. Optional additional centralization with incision in the middle part of the meniscus. Reinforcement of the meniscus base with braided suture material using the "outside in" technique and fixation of the inner meniscus base at the edge of the tibial plateau using a transosseous extraction suture or a suture anchor.
Six weeks nonweight-bearing (0 kg), then gradually increased load. Range of motion: 4 weeks E/F 0-0-60°, 2 weeks 0-0-90°, optionally use of a valgus brace (varus of < 5°).
In root lesions of the medial meniscus, transosseous refixation significantly improves knee function (Lysholm, Hospital for Special Surgery, International Knee Documentation Committee, visual analog scale for pain, Tegner, and Knee Injury and Osteoarthritis Outcome scores) and reduces osteoarthritis progression. However, a transosseous suture alone could not significantly reduce postoperative extrusion. However, previous studies have shown that additional centralization can significantly reduce extrusion.
通过胫骨钻孔隧道对内侧半月板后根损伤进行重新固定，并使用半月板胫骨缝线防止其挤出（复位）。
内侧半月板后根损伤。
相应关节间室4级软骨损伤、未矫正的内翻或外翻畸形、症状性不稳定、除根部区域外的广泛退行性撕裂。
通过前外侧标准高位入路进行膝关节镜检查。诊断性关节镜检查以核实适应证。在胫骨平台上确定植入区域并进行局部清创，直至可见胫骨平台骨质。插入定位装置并将定位导丝钻入髁间隆起区域植入区域的中心。用4.5毫米钻头扩大导丝钻孔。用编织缝合材料加强内侧半月板后角。通过带线环的带孔导丝将加强缝线插入骨隧道。可选择在半月板中部切开进行额外的复位。使用“由外向内”技术用编织缝合材料加强半月板基部，并使用经骨抽出缝线或缝合锚钉将内侧半月板基部固定在胫骨平台边缘。
六周不负重（0千克），然后逐渐增加负重。活动范围：4周伸直/屈曲0-0-60°，2周0-0-90°，可选择使用外翻支具（内翻小于5°）。
在内侧半月板根部损伤中，经骨重新固定可显著改善膝关节功能（Lysholm评分、特种外科医院评分、国际膝关节文献委员会评分、疼痛视觉模拟量表评分、Tegner评分以及膝关节损伤和骨关节炎疗效评分），并减少骨关节炎进展。然而，单纯的经骨缝合并不能显著减少术后挤出。不过，先前的研究表明，额外的复位可显著减少挤出。
