Srisuwanporn Pinij, Laksawut Suriya, Tanulugpairoj Jiradeth, Chinakarn Yottawee, Khunvejvaidya Phichit, Thantong Banchong
Sports Medicine Service, Department of Orthopedics, Rajavithi Hospital, Bangkok, Thailand.
Biomedical Engineering, Department of Medical Innovation, Rajavithi Hospital, Bangkok, Thailand.
Asia Pac J Sports Med Arthrosc Rehabil Technol. 2024 Sep 25;38:36-42. doi: 10.1016/j.asmart.2024.09.001. eCollection 2024 Oct.
In order to do arthroscopic surgery on medial meniscus injuries, there must be enough joint space and good visibility for instrumentation. There is a possibility of iatrogenic cartilage damage if the medial joint space is reduced. Therefore, a medial collateral ligament (MCL) releasing procedure may be necessary for the majority of individuals with medial knee tightness. The MCL residual laxity after pie-crusting release during arthroscopic medial meniscus repair in medial knee tightness were studied in this study.
Between July 2022 and June 2023, fourteen patients (4 male, 10 female) underwent medial meniscus surgery with pie-crusting release of the superficial MCL. Mean age was 50 ± 10 years (range, 35-63 years). Medial meniscal lesions were meniscus root tear in 10 cases (71.5 %), longitudinal tear in 2 (14.5 %), horizontal tear in 1 (7 %) and radial tear in 1 (7 %). Preoperatively, valgus stress radiographs were obtained. During surgery if arthroscopic exploration revealed medial joint space narrowing after applying valgus force with the knee in 20 degrees of flexion, pie-crusting MCL release was performed. At the 3-month follow-up, valgus stress radiographs were obtained. Residual MCL laxity was assessed by comparing preoperative and 3-month follow-up medial joint space width measurements.
At the 3-month follow-up, no significant increase in the medial joint space width on valgus stress radiograph was observed in comparison to the preoperative. The medial joint space width on valgus stress radiograph was 7.42 ± 1.16 mm preoperatively and 7.47 ± 1.15 mm at 3-month postoperatively ( value = 0.914). All patients had no intraoperative iatrogenic cartilage injury and no saphenous nerve injury after operation.
The magic point pie-crusting MCL release is a reliable and useful procedure to arthroscopic surgery in patients with medial meniscal injury and medial knee tightness. Furthermore, percutaneous pie-crusting MCL release had no effect on residual valgus laxity at the last follow-up.
为了对内侧半月板损伤进行关节镜手术，必须有足够的关节间隙且器械操作视野良好。如果内侧关节间隙减小，存在医源性软骨损伤的可能性。因此，对于大多数膝关节内侧紧张的患者，可能需要进行内侧副韧带（MCL）松解术。本研究对膝关节内侧紧张患者在关节镜下内侧半月板修复术中采用“饼皮样”松解后MCL的残余松弛情况进行了研究。
2022年7月至2023年6月，14例患者（4例男性，10例女性）接受了内侧半月板手术，并对浅层MCL进行了“饼皮样”松解。平均年龄为50±10岁（范围35 - 63岁）。内侧半月板损伤中，半月板根部撕裂10例（71.5%），纵向撕裂2例（14.5%），水平撕裂1例（7%），放射状撕裂1例（7%）。术前拍摄外翻应力X线片。手术中，如果关节镜探查发现膝关节在20度屈曲位施加外翻力后内侧关节间隙变窄，则进行“饼皮样”MCL松解。在3个月随访时，拍摄外翻应力X线片。通过比较术前和3个月随访时内侧关节间隙宽度测量值来评估MCL残余松弛情况。
在3个月随访时，与术前相比，外翻应力X线片上内侧关节间隙宽度无显著增加。术前外翻应力X线片上内侧关节间隙宽度为7.42±1.16mm，术后3个月为7.47±1.15mm（P值 = 0.914）。所有患者术中均无医源性软骨损伤，术后无隐神经损伤。
“饼皮样”MCL松解术对于内侧半月板损伤和膝关节内侧紧张的患者进行关节镜手术是一种可靠且有用的方法。此外，经皮“饼皮样”MCL松解术在最后随访时对外翻残余松弛无影响。
