Mabrouk Ahmed, Onishi Shintaro, Jacquet Christophe, Cavaignac Etienne, Guenoun Daphne, Ollivier Matthieu
Leeds Teaching Hospitals, Department of Trauma and Orthopaedics, Leeds, United Kingdom; Aix-Marseille University, APHM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Marseille, France.
Aix-Marseille University, APHM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Marseille, France.
Orthop Traumatol Surg Res. 2025 Apr;111(2):104025. doi: 10.1016/j.otsr.2024.104025. Epub 2024 Oct 18.
Degenerative medial meniscus tears are a common pathology in the general population. Recent randomized trials demonstrated non-superiority of arthroscopic partial meniscectomy over conservative management. However, there is a paucity of information regarding the outcomes of combined conservative treatments.
It was hypothesized that combined intra- and perimeniscal corticosteroid injections with structured physiotherapy, for degenerative medial meniscus tears, would result in high surgery-free and second injection-free survivorship.
A retrospective review of 671 patients with symptomatic degenerative medial meniscus tears, who received intra- and perimeniscal corticosteroids injection combined with structured physiotherapy, was conducted. An ultrasound-guided injection of Triamcinolone Hexacetonide 20 mg/ml comprised; 1.5 ml intra-meniscal,1.5 ml in the meniscal wall, and 2 ml in the peri-meniscal space, was performed. Surgery free- and a second injection free-survivorship were analysed. Western Ontario and Macmaster University scores (WOMAC), Tegner activity scores, patient satisfaction, return-to-work status and average time to return to work were recorded.
A total of 481 patients who met the inclusion criteria were included. The mean age was 51.1 ± 7.9 years. At five years post-procedure, surgery-free, and second injection-free survivorship of the ipsilateral knee was 83%, and 52%, respectively. A multivariate analysis adjusting survival on parametric risk factors identified that only effusion before steroid injection was an independent risk factor of treatment failure. At a mean follow-up of 4 ± 2 years, there was an improvement in WOMAC scores by 5.2 ± 4.9 for pain, by 2 ± 2 for stiffness, by 7.3 ± 7.4 for function, and by 12.4 ± 12.7 for the global scores. Additionally, there was significant improvement in the Tegner activity scores (All p < 0.001). Knee effusion and advanced osteoarthritis (Kellgren-Lawrence > III) were significantly associated with poorer outcomes; p < 0.003 and p < 0.0004, respectively.
A combination of intra- and perimeniscal corticosteroid injections and structured physiotherapy for degenerative medial meniscus tears, results in high surgery-free (83%) and second injection-free (52%) survivorship, as well as, effective clinical outcomes and satisfaction at 5 years.
IV; Retrospective Case Series.
退行性内侧半月板撕裂是普通人群中的常见病症。近期的随机试验表明，关节镜下部分半月板切除术并不优于保守治疗。然而，关于联合保守治疗的结果，相关信息较少。
假设对于退行性内侧半月板撕裂，半月板内及半月板周围注射皮质类固醇并结合结构化物理治疗，将产生较高的无手术和无二次注射生存率。
对671例有症状的退行性内侧半月板撕裂患者进行回顾性研究，这些患者接受了半月板内及半月板周围皮质类固醇注射并结合结构化物理治疗。采用超声引导注射20mg/ml己曲安奈德，其中半月板内注射1.5ml，半月板壁注射1.5ml，半月板周围间隙注射2ml。分析无手术和无二次注射生存率。记录西安大略和麦克马斯特大学骨关节炎指数（WOMAC）评分、Tegner活动评分、患者满意度、重返工作状态及平均重返工作时间。
共纳入481例符合纳入标准的患者。平均年龄为51.1±7.9岁。术后5年，同侧膝关节的无手术生存率和无二次注射生存率分别为83%和52%。对参数风险因素进行生存调整的多变量分析确定，仅类固醇注射前的积液是治疗失败的独立风险因素。平均随访4±2年，WOMAC评分在疼痛方面改善了5.2±4.9，僵硬方面改善了2±2，功能方面改善了7.3±7.4，总体评分改善了12.4±12.7。此外，Tegner活动评分有显著改善（所有p<0.001）。膝关节积液和重度骨关节炎（Kellgren-Lawrence>III级）与较差的预后显著相关，分别为p<0.003和p<0.0004。
对于退行性内侧半月板撕裂，半月板内及半月板周围注射皮质类固醇并结合结构化物理治疗，可产生较高的无手术生存率（83%）和无二次注射生存率（52%），以及5年时有效的临床结果和满意度。
IV级；回顾性病例系列。
