Gerhold Cameron, Dave Udit, Bi Andrew S, Chahla Jorge
Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.
Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A..
Arthroscopy. 2025 Apr;41(4):871-873. doi: 10.1016/j.arthro.2025.01.005.
Meniscal root tears are defined as complete avulsions of the meniscus at the site of tibial attachment or meniscal tears within 1 cm of the meniscotibial attachment sites. This injury often is seen in individuals older than the age of 50 years who have a sedentary lifestyle and can lead to the progression of osteoarthritis if not treated properly; in contrast, a traumatic etiology may be observed in younger individuals. Recent literature has defined the association between medial meniscal root tears and meniscal extrusion, defined by >2 mm of overhang of the medial meniscus over the medial border of the tibial plateau. Surgical repair often is indicated for unstable meniscal root tears, as these injuries are functionally equivalent to a total meniscectomy because of a complete loss of circumferential fibers and hoop stresses. There are 2 main repair techniques: transtibial pullout and suture anchor repairs. Repair using the transtibial pullout technique involves drilling a tunnel from the anterior proximal tibia to the anatomic insertion site of the meniscal root. Sutures are then passed through the medial root, retrieved through the tunnel, and secured with a cortical button or suture anchor on the anterior tibial cortex. Suture anchor repairs either involve passing sutures through the meniscal root and into a suture anchor at the footprint. A supplemental centralization technique is a new advancement designed to reduce meniscal extrusion and involves fixation of the meniscal body with a suture anchor at the peripheral medial plateau. Medial meniscal root repair is associated with improved patient-reported outcomes and a reduced rate of knee replacement.
半月板根部撕裂被定义为半月板在胫骨附着部位的完全撕脱或在半月板胫骨附着部位1厘米范围内的半月板撕裂。这种损伤常见于50岁以上久坐不动的人群，如果治疗不当，可能会导致骨关节炎的进展；相比之下，年轻个体可能有创伤性病因。最近的文献已经明确了内侧半月板根部撕裂与半月板挤出之间的关联，半月板挤出的定义为内侧半月板在胫骨平台内侧边缘的悬垂超过2毫米。对于不稳定的半月板根部撕裂，通常需要手术修复，因为这些损伤由于圆周纤维和环向应力的完全丧失，在功能上等同于全半月板切除术。有两种主要的修复技术：经胫骨拉出法和缝线锚钉修复法。使用经胫骨拉出技术进行修复时，需从前近端胫骨向半月板根部的解剖插入部位钻一个隧道。然后将缝线穿过内侧根部，从隧道中取出，并在前胫骨皮质上用皮质纽扣或缝线锚钉固定。缝线锚钉修复法包括将缝线穿过半月板根部并插入足迹处的缝线锚钉。一种补充性的半月板复位技术是一项旨在减少半月板挤出的新进展，它涉及用缝线锚钉将半月板体固定在胫骨平台内侧周边。内侧半月板根部修复与患者报告的结果改善以及膝关节置换率降低相关。
