Bo Seung Bae, Kim Dong Hyun, Koo Bon-Ki, Lee Sang Hak
Department of Orthopedic Surgery, Kyung Hee University Hospital, Seoul, Republic of Korea.
Department of Orthopedic Surgery, Center for Joint Diseases and Rheumatism, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea.
Orthop Traumatol Surg Res. 2025 Apr;111(2):104016. doi: 10.1016/j.otsr.2024.104016. Epub 2024 Oct 3.
The popliteal hiatus stabilizes the lateral meniscus (LM). Variable failure rates for LM repairs have been reported in knees with lateral meniscal tears (LMTs), which may be attributable to low vascularity around the popliteal hiatus. An effective repair method is essential to enhance the biological healing and stability of LMTs around the popliteal hiatus.
Arthroscopic repair of LMTs, including the popliteus tendon around the popliteal hiatus, is expected to produce a low reoperation rate and effective treatment, both clinically and radiographically.
From June 2011 to August 2020, 93 patients (mean age 27.9 ± 13.5 years) who underwent arthroscopic repair of LMTs including the popliteus tendon around the popliteal hiatus were enrolled. Patients with LMTs were divided into three groups: isolated LMTs, discoid LMTs, and LMTs with ACL injury. Patients had a minimum clinical follow-up of 2 years (mean 37.9 ± 19.3 months) and Tegner activity, Lysholm knee, and Hospital for Special Surgery (HSS) scores were evaluated for all patients. The widths of the popliteal hiatus and LM extrusion were measured on the sagittal and coronal planes using preoperative and postoperative magnetic resonance imaging (MRI).
The Tegner activity (2.6 ± 1.2-4.5 ± 1.3), Lysholm (67.9 ± 14.2-88.1 ± 6.4), and HSS scores (79.8 ± 11.5-93.7 ± 5.1) were significantly improved in all knees (p < 0.001). The width of the popliteal hiatus measured on MRI was significantly decreased, when comparing the preoperative and postoperative MRI for all knees (sagittal plane, 2.9 ± 1.4-1.5 ± 0.5 mm; coronal plane, 3.8 ± 2.5 to 1.9 ± 1.0 mm) (p < 0.05). The LM extrusion measured on the sagittal plane of postoperative MRI was also significantly reduced after arthroscopic repair (24.8 ± 3.1-23.7 ± 2.8 mm) (p = 0.001). Five reoperations (5/93, 5.3%) were performed, suggesting a clinical failure.
Arthroscopic repair of isolated, discoid and post-traumatic LMTs including the popliteus tendon around the popliteal hiatus, is an effective surgical treatment for LM stabilization.
Level IV, retrospective series.
腘肌腱裂孔可稳定外侧半月板（LM）。据报道，外侧半月板撕裂（LMT）患者行LM修复的失败率各异，这可能归因于腘肌腱裂孔周围血管较少。一种有效的修复方法对于提高腘肌腱裂孔周围LMT的生物愈合和稳定性至关重要。
关节镜下修复LMT，包括腘肌腱裂孔周围的腘肌腱，有望在临床和影像学上实现低再手术率和有效治疗。
纳入2011年6月至2020年8月期间93例行关节镜下修复LMT（包括腘肌腱裂孔周围的腘肌腱）的患者（平均年龄27.9±13.5岁）。LMT患者分为三组：孤立性LMT、盘状LMT和合并前交叉韧带损伤的LMT。所有患者的临床随访时间至少为2年（平均37.9±19.3个月），并评估Tegner活动度、Lysholm膝关节评分和特殊外科医院（HSS）评分。使用术前和术后磁共振成像（MRI）在矢状面和冠状面上测量腘肌腱裂孔的宽度和LM挤压程度。
所有膝关节的Tegner活动度（2.6±1.2 - 4.5±1.3）、Lysholm评分（67.9±14.2 - 88.1±6.4）和HSS评分（79.8±11.5 - 93.7±5.1）均显著改善（p < 0.001）。比较所有膝关节术前和术后MRI时，MRI测量的腘肌腱裂孔宽度显著减小（矢状面，2.9±1.4 - 1.5±0.5 mm；冠状面，3.8±2.5至1.9±1.0 mm）（p < 0.05）。关节镜修复后，术后MRI矢状面上测量的LM挤压程度也显著降低（24.8±3.1 - 23.7±2.8 mm）（p = 0.001）。进行了5次再手术（5/93，5.3%），提示临床失败。
关节镜下修复孤立性、盘状和创伤后LMT，包括腘肌腱裂孔周围的腘肌腱，是一种稳定LM的有效手术治疗方法。
IV级，回顾性系列研究。
