Kimura M, Shirakura K, Hasegawa A, Kobuna Y, Niijima M
Gunma Sports Medicine Research Center, Zenshukai Hospital, Japan.
Clin Orthop Relat Res. 1995 May(314):185-91.
Second look arthroscopy was performed on 46 of 137 consecutive patients who underwent arthroscopic meniscal repair. All tears were of the vertical type. Thirty-two tears were located in avascularized areas. Thirty-one patients had associated anterior cruciate ligament insufficiencies. Anterior cruciate ligament reconstructions were performed simultaneously on 26 patients. The double-needle cannula method was used in all the patients. An additional transplantation of a vascularized synovial pedicle flap to the suture site was performed on 7 tears in avascularized areas. Second look arthroscopy showed no healing in 8 patients and healing in 38. Four of the 8 unhealed tears were located in avascularized areas, and 4 had unreconstructed anterior cruciate ligament injuries respectively. All 7 patients with synovial pedicle flaps showed healing. All patients with anterior cruciate ligament reconstructions showed healing, and the healing rate was significantly higher than that of the other patients (p < 0.005). Patients with anterior cruciate ligament insufficiencies showed a significantly lower healing rate than the others (p < 0.005). In patients with tears in avascularized areas, the conventional meniscal repairs showed a lower healing rate than did the repairs with a synovial pedicle transplantation or an anterior cruciate ligament reconstruction (p < 0.005). These results suggest that the most important factors influencing meniscal healing are the presence of anterior cruciate ligament tears, ligamentous reconstruction, and vascularity of the tear site.
在137例连续接受关节镜下半月板修复的患者中，对46例进行了二次关节镜检查。所有撕裂均为垂直型。32处撕裂位于无血管区域。31例患者伴有前交叉韧带功能不全。26例患者同时进行了前交叉韧带重建。所有患者均采用双针套管法。对7处无血管区域的撕裂，额外进行了带血管蒂滑膜瓣移植至缝合部位。二次关节镜检查显示，8例未愈合，38例愈合。8例未愈合的撕裂中，4例位于无血管区域，4例分别伴有未重建的前交叉韧带损伤。所有7例接受滑膜瓣移植的患者均愈合。所有接受前交叉韧带重建的患者均愈合，且愈合率显著高于其他患者（p<0.005）。前交叉韧带功能不全的患者愈合率显著低于其他患者（p<0.005）。在无血管区域有撕裂的患者中，传统半月板修复的愈合率低于带滑膜蒂移植或前交叉韧带重建的修复（p<0.005）。这些结果表明，影响半月板愈合的最重要因素是前交叉韧带撕裂的存在、韧带重建以及撕裂部位的血管情况。
