Ihara H, Miwa M, Takayanagi K, Nakayama A
Department of Orthopaedic Surgery, Kyushu Rosai Hospital, Kitakyushu, Japan.
Clin Orthop Relat Res. 1994 Oct(307):146-54.
The purpose of this study was to evaluate arthroscopically the natural healing of an acute torn meniscus combined with an acute cruciate ligament injury treated nonoperatively. There were 30 lateral and 10 medial meniscus tears associated with 25 acute anterior cruciate ligament and 7 posterior cruciate ligament injuries in 32 patients. There was more than 1 tear on some menisci for a total of 51 tear sites. Injuries to the menisci and ligaments were allowed to heal without surgery, but were given protective mobilization immediately in order to stimulate stress oriented healing of injured collagen fibers and promote circulation of synovial fluid to the meniscus and ligament. A Kyuro knee brace with a coil spring traction system was used to add adequate but not excessive stress to the associated injured cruciate ligament. All knees were examined and arthroscoped before and after a 3-month treatment period. Results indicated that 69% of the lateral menisci healed completely and 18% healed partially, whereas 58% of the medial menisci healed completely and none healed partially. Twenty of 25 anterior cruciate ligaments and 3 of 7 posterior cruciate ligaments healed satisfactorily. This study indicated that acute tears of the meniscus, even when they occur in association with a cruciate ligament injury, can heal morphologically with nonsurgical treatment.
本研究的目的是通过关节镜评估非手术治疗的急性半月板撕裂合并急性十字韧带损伤的自然愈合情况。32例患者中，有30例外侧半月板撕裂和10例内侧半月板撕裂，伴有25例急性前交叉韧带损伤和7例后交叉韧带损伤。部分半月板存在多处撕裂，共计51个撕裂部位。半月板和韧带损伤未经手术自行愈合，但立即给予保护性活动，以刺激损伤胶原纤维的应力性愈合，并促进滑膜液向半月板和韧带的循环。使用带有螺旋弹簧牵引系统的久留膝盖支具，对相关损伤的十字韧带施加适当但不过度的应力。在3个月的治疗期前后，对所有膝关节进行检查和关节镜检查。结果显示，69%的外侧半月板完全愈合，18%部分愈合，而58%的内侧半月板完全愈合，无部分愈合情况。25条前交叉韧带中的20条和7条后交叉韧带中的3条愈合情况良好。本研究表明，半月板急性撕裂即使与十字韧带损伤同时发生，非手术治疗也可使其在形态上愈合。
