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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >Clinical Outcomes of Medial Meniscus Posterior Root Tears
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Clinical Outcomes of Medial Meniscus Posterior Root Tears

机译：内侧半月板后根撕裂的临床结果

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Objectives: Medial meniscus posterior root tears (MMPRTs) present a unique challenge for both patients and surgeons as these tears have shown to be biomechanically equivalent to complete meniscectomy. However, little is known about the natural history of these lesions. Therefore, the purpose of this study is to describe the clinical course of MMPRTs with respect to subsequent operative and non-operative treatments, and associated comorbidities. Methods: Over 2600 MRIs were identified by searching radiologist reads for the terms “root” or “root tear” from 2005-2013. Presence or absence of MMPRTs and other associated boney, meniscal, or ligamentous injuries were identified and recorded. Of these MRIs, 102 MRIs from 102 patients who had unrepaired MMPRTs with minimum 2-year follow-up and no prior ligamentous surgery were followed. These MRIs were evaluated to confirm the presence of a meniscal root tear and the presence or absence of associated meniscal or ligamentous injuries, as well as meniscal extrusion, subchondral edema, or insufficiency fractures. Chart review was performed to obtain the treatment summary after diagnosis. Radiographs from before and after the diagnosis of MMPRT were reviewed and Kellgren-Lawrence scores were determined. Finally, the association between concomitant boney, ligamentous, or meniscal injuries, patient factors, and rate of arthroplasty, as well as final Kellgren-Lawrence scores were evaluated. Chi-square analysis was used for categorical variables, and Wilcoxon Rank-Sums was used for continuous variables. Kaplan-Meier analysis was used to evaluate the effect of meniscal extrusion on the time-dependant rate of arthroplasty. Results: 104 patients (43 M:61F) were diagnosed with MMPRTs at a mean age of 54±13. These patients were followed for a mean of 66±26 months. 75 (74%) patients had associated meniscal extrusion, 64 (62%) had associated subchondral edema, and 14 (13%) had associated insufficiency fractures at the time of diagnosis. After initial diagnosis, 59 (58%) underwent subsequent surgical treatment. This included 52 (51%) patients undergoing arthroscopic partial meniscectomy, and 29 (28%) patients undergoing total knee arthroplasty at a mean 38±32 (range 3-107) months after MRI. Kellgren-Lawrence grades worsened from 1.3±0.7 before diagnosis to 2.2±1.0 after (p<0.001), with a mean 44±32 months between radiographs. There was a higher rate of radiographic arthritis (K-L grade 2+) after diagnosis (73%) than before diagnosis (36%) (p<0.001). The presence of meniscal extrusion on MRI was associated with the presence of arthritis on post-diagnosis radiographs (p=0.03). Meniscal extrusion, subchondral edema, and insufficiency fractures were not associated with increased rates of surgical treatment, or time to arthroplasty. Conclusion: Little information is available to guide patients and physicians on the clinical outcomes for MMPRTs. These injuries are associated with a relatively high rate of arthroplasty and worsening arthritis, especially with concomitant meniscal extrusion. More information is needed to determine the efficacy of meniscal root repair in preventing these unfavorable outcomes.
机译：目的：内侧半月板后根撕裂术（MMPRTs）对患者和外科医生都提出了独特的挑战，因为这些撕裂已显示出与完全半月板切除术生物等效。但是，对这些病变的自然病程知之甚少。因此，本研究的目的是描述MMPRTs在随后的手术和非手术治疗以及相关合并症方面的临床过程。方法：通过搜索放射科医生的阅读资料，从2005-2013年期间识别出“根”或“根撕裂”一词，从而识别出2600多个MRI。识别并记录MMPRTs是否存在以及其他相关的骨伤，半月板病或韧带损伤。在这些MRI中，对102例未修复MMPRT并进行了至少2年随访且未进行过韧带手术的患者的102 MRI进行了随访。对这些MRI进行评估，以确认是否存在半月板根部撕裂以及是否存在相关的半月板或韧带损伤，以及半月板挤压，软骨下水肿或骨折不足。诊断后进行图表回顾以获得治疗总结。回顾了MMPRT诊断前后的X光片，并确定了Kellgren-Lawrence得分。最后，评估了伴随的骨，韧带或半月板损伤，患者因素和关节置换率以及最终的Kellgren-Lawrence评分之间的关​​联。卡方分析用于分类变量，Wilcoxon Rank-Sums用于连续变量。 Kaplan-Meier分析用于评估半月板挤压对关节置换术的时间依赖性速率的影响。结果：104名患者（43 M：61F）被诊断出患有MMPRT，平均年龄为54±13。这些患者平均随访66±26个月。在诊断时，有75例（74％）患者伴有半月板挤压，64例（62％）患者伴有软骨下水肿和14例（13％）患者伴有功能不全骨折。初步诊断后，有59（58％）人接受了后续手术治疗。其中包括52例（51％）接受关节镜部分半月板切除术的患者和29例（28％）接受MRI后平均38±32（范围3-107）个月的全膝关节置换术的患者。 Kellgren-Lawrence评分从诊断前的1.3±0.7恶化至诊断后的2.2±1.0（p <0.001），X线片平均间隔44±32个月。诊断后放射影像性关节炎（K-L 2+级）的发生率（73％）高于诊断前（36％）（p <0.001）。 MRI上半月板挤压的存在与诊断后X线片上关节炎的存在相关（p = 0.03）。半月板挤压，软骨下水肿和功能不全骨折与手术治疗率或置换时间无关。结论：关于MMPRTs临床结果的信息很少，无法指导患者和医生。这些伤害与相对较高的置换率和恶化的关节炎有关，特别是伴随着半月板挤压。需要更多信息来确定半月板根修复在预防这些不利结果方面的功效。

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