Shelbourne K D, Johnson G E
Methodist Sports Medicine Center, Indianapolis, Indiana.
Am J Sports Med. 1993 Nov-Dec;21(6):779-82; discussion 782. doi: 10.1177/036354659302100604.
Because we noticed patients had difficulty regaining full range of motion after surgery for a locked bucket-handle meniscal tear with simultaneous reconstruction for a chronic anterior cruciate ligament tear, we adopted a two-stage procedure for this group of patients. We evaluated the results of a two-stage procedure in the knees of 16 athletes (Group 1) and compared their outcome with the outcome of 16 matched athletes who had been treated with simultaneous repair or removal of the displaced bucket-handle meniscal tear and autogenous patellar tendon anterior cruciate ligament reconstruction (Group 2). Four patients in Group 2 required a second procedure or casting to regain full extension. No patient in Group 1 required a second procedure. One meniscal retear was detected in Group 1. The two-stage procedure also appears to have a number of theoretical advantages: 1) more aggressive use of repair rather than removal of a displaced torn meniscus, 2) prevention of problems in regaining range of motion, 3) allows a second look to judge the success of meniscal repair, and 4) allows time for the patient to prepare for anterior cruciate ligament reconstruction physically, mentally, academically, and socially.
因为我们注意到，对于伴有慢性前交叉韧带撕裂并同时进行重建的锁定式桶柄状半月板撕裂患者，术后很难恢复到完全活动范围，所以我们对这组患者采用了两阶段手术。我们评估了16名运动员（第1组）膝关节两阶段手术的结果，并将其结果与16名匹配的运动员（第2组）的结果进行比较，第2组运动员接受了同时修复或切除移位的桶柄状半月板撕裂以及自体髌腱前交叉韧带重建治疗。第2组中有4名患者需要进行第二次手术或石膏固定以恢复完全伸直。第1组中没有患者需要进行第二次手术。在第1组中检测到1例半月板再次撕裂。两阶段手术似乎也有许多理论上的优势：1）更积极地采用修复而非切除移位的撕裂半月板；2）防止恢复活动范围时出现问题；3）可以再次检查以判断半月板修复的成功率；4）让患者有时间在身体、心理、学业和社交方面为前交叉韧带重建做好准备。
