与半月板修复相比，在同时存在半月板和前交叉韧带撕裂的患者进行前交叉韧带重建术后，部分半月板切除术增加了前交叉韧带翻修手术的风险。
Partial Meniscectomy Increases Risk of Anterior Cruciate Ligament Revision Surgery Compared With Meniscus Repair in Patients With Concurrent Meniscus and Anterior Cruciate Ligament Tears After Anterior Cruciate Ligament Reconstruction.
作者信息
Balu Abhinav R, Chopra Avani, Demanes Augustus, Shen Peter C, Balu Rithvik R, Terry Michael, Tjong Vehniah K
机构信息
Department of Orthopaedic Surgery, Northwestern Feinberg School of Medicine, Chicago, Illinois, U.S.A..
Department of Orthopaedic Surgery, Northwestern Feinberg School of Medicine, Chicago, Illinois, U.S.A.; Penn State College of Medicine, Hershey, Pennsylvania, U.S.A.
出版信息
Arthroscopy. 2025 May 13. doi: 10.1016/j.arthro.2025.05.006.
PURPOSE
To compare the rates of revision anterior cruciate ligament (ACL) reconstruction, meniscal reoperation, and total knee arthroplasty associated with partial meniscectomy and meniscal repair performed at the time of index ACL reconstruction in patients with concurrent meniscus and ACL tears.
METHODS
The TriNetX database was queried for patients undergoing ACL reconstruction after January 1, 2000, with minimum 1-year clinical follow up. Inclusion criteria for this study were patients who had partial meniscectomy, meniscal repair, or isolated ACL reconstruction without meniscus injury. Statistical analyses were performed using Python with significance thresholds of P < .05.
RESULTS
A total of 39,126 patients were followed for an average of 5.02 years. Patients undergoing meniscal repair were less likely to experience revision ACL reconstruction compared with those undergoing partial meniscectomy (relative risk [RR] 0.78, confidence interval [CI] 0.71-0.85, P < .001). Meniscus reoperation occurred significantly more in patients undergoing meniscal repair (RR 1.26, CI 1.17-1.35, P < .001) than those undergoing partial meniscectomy. Regarding total knee arthroplasty, partial meniscectomy carried a more than 6-fold increased risk compared with isolated ACL reconstruction (RR 6.4, CI 2.49-16.42, P < .001).
CONCLUSIONS
In patients with ACL injury, ACL reconstruction, and concurrent meniscus tear, those patients treated with meniscus repair were less likely to undergo revision surgery. In these patients, medial meniscal injuries were associated with ACL revision than lateral meniscal injury regardless of the method of treatment. When meniscus repair is performed, this is associated with lower rate of future total knee arthroplasty.
LEVEL OF EVIDENCE
Level III, retrospective cohort study.
目的
比较同期存在半月板和前交叉韧带（ACL）撕裂的患者，在初次ACL重建时行部分半月板切除术和半月板修复术后，翻修ACL重建、半月板再次手术及全膝关节置换的发生率。
方法
查询TriNetX数据库中2000年1月1日以后接受ACL重建且临床随访至少1年的患者。本研究的纳入标准为行部分半月板切除术、半月板修复术或单纯ACL重建而无半月板损伤的患者。使用Python进行统计分析，显著性阈值为P < .05。
结果
共对39126例患者进行了平均5.02年的随访。与接受部分半月板切除术的患者相比，接受半月板修复术的患者翻修ACL重建的可能性更小（相对风险[RR] 0.78，置信区间[CI] 0.71 - 0.85，P < .001）。接受半月板修复术的患者半月板再次手术的发生率显著高于接受部分半月板切除术的患者（RR 1.26，CI 1.17 - 1.35，P < .001）。关于全膝关节置换，与单纯ACL重建相比，部分半月板切除术的风险增加了6倍以上（RR 6.4，CI 2.49 - 16.42，P < .001）。
结论
在ACL损伤、ACL重建且合并半月板撕裂的患者中，接受半月板修复术的患者进行翻修手术的可能性较小。在这些患者中，无论治疗方法如何，内侧半月板损伤比外侧半月板损伤与ACL翻修的相关性更高。当进行半月板修复时，这与未来全膝关节置换的发生率较低相关。
证据水平
III级，回顾性队列研究。
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