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编辑评论:半月板修复与半月板切除术的比例已有所改善,且应继续改善。

Editorial Commentary: Rate of Meniscal Repair Versus Meniscectomy Has Improved and Should Continue to Improve.

作者信息

Jha Vivek

出版信息

Arthroscopy. 2025 Jun;41(6):1928-1930. doi: 10.1016/j.arthro.2024.10.006. Epub 2024 Oct 12.

DOI:10.1016/j.arthro.2024.10.006
PMID:39401688
Abstract

As a result of research supporting meniscus preservation, evidence shows that internationally, there has been a rise in rates of meniscus repair, especially in younger population, and a decline in rates of partial meniscectomy. The decline in partial meniscectomy has been rather rapid and has outpaced the rise in meniscal repair, likely due to increasing evidence against routine partial meniscectomy in degenerative tears with coexistent arthritis. However, despite the rise in meniscus repair, close to 95% of meniscus surgeries are still partial meniscectomies. The partial meniscectomy to meniscus repair ratio seems to be rather high. Optimistically, this will improve because successful repair outcomes have been demonstrated in situations previously considered "high-risk," including complex patterns, central tears, radial tears, and root and ramp tears. This may be due to multiple factors, many of which may be beyond the control of surgeons, including the fact that as many as 25% of repairs fail to heal. Yet, with improved techniques and instrumentation, the success rate of repair is improving. The cost of repair may be a limiting factor, especially in low-income countries with poor health insurance penetration and unfavorable reimbursement of repair cost. Every effort must be made to repair a tear, which has potential to heal.

摘要

由于支持半月板保留的研究,有证据表明,在国际上,半月板修复率有所上升,尤其是在年轻人群中,而部分半月板切除术的比率则有所下降。部分半月板切除术的下降相当迅速,且超过了半月板修复率的上升,这可能是因为越来越多的证据表明,对于伴有关节炎的退行性撕裂,常规的部分半月板切除术是不可取的。然而,尽管半月板修复率有所上升,但仍有近95%的半月板手术是部分半月板切除术。部分半月板切除术与半月板修复术的比例似乎相当高。乐观的是,这种情况将会改善,因为在以前被认为是“高风险”的情况下,如复杂模式、中央撕裂、放射状撕裂以及根部和斜坡撕裂,已经证明了修复手术的成功结果。这可能是由多种因素导致的,其中许多因素可能超出了外科医生的控制范围,包括多达25%的修复手术未能愈合这一事实。然而,随着技术和器械的改进,修复的成功率正在提高。修复的成本可能是一个限制因素,尤其是在医疗保险普及率低且修复费用报销不利的低收入国家。对于有可能愈合的撕裂,必须尽一切努力进行修复。

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