外侧半月板后根修复对前交叉韧带重建后膝关节稳定性的影响

The effect of lateral meniscus posterior root repair on the stability of anterior cruciate ligament reconstructed knee

目的评估外侧半月板后根修复或部分切除对前交叉韧带(ACL)重建后膝关节稳定性的影响是否存在差异。方法回顾性收集2018年6月至2022年3月经关节镜诊断为ACL撕裂合并外侧半月板后根撕裂(LMPRT)的患者,根据不同术式分为2组,A组行ACL重建+LMPR修复;B组行ACL重建+LMPR部分切除术。此外,随机匹配同时期单纯ACL撕裂行ACL重建患者作为对照组(C组)。所有患者随访12个月以上。根据Lysholm评分、国际膝关节评分委员会(IKDC)评分评估膝关节客观功能,通过轴移试验、基于MRI测量的胫骨前半脱位(ATS)、外侧半月板外突(LME)、胫骨结节-滑车沟(TT-TG)间距、股骨胫骨旋转(FTR)角评估膝关节稳定性。结果共纳入患者45例,男性30例,女性15例,平均年龄(33.98±11.00)岁,随访时间(14.54±1.88)个月。与术前相比,末次随访时各组患者Lysholm评分、IK-DC评分、ATS、TT-TG与FTR结果均显著改善(P<0.05);A组末次随访时LME与术前相比存在显著改善(P<0.05)。组间比较:(1)术前,C组的Lysholm评分、IKDC评分、轴移试验结果、ATS、LME等指标显著优于A、B两组(P<0.05);各组TT-TG和FTR无显著差异(P>0.05)。(2)术后,B组轴移试验显著强于A、C两组(P<0.05),A、C两组的轴移试验无显著差异(P>0.05)。(3)末次随访时,A、C两组的自主功能评分和LME均显著优于BB组(P<0.05);B组ATS显著高于C组(P<0.05);A组与C组患者自主功能评分、ATS、LME均无显著差异(P>0.05);各组TT-TG与FTR无显著差异(P>0.05)。结论LMPRT修复可进一步提高ACL重建后膝关节的前向和旋转稳定性,并减少LME,提高患者自主功能评分。

Objective This study was to investigate the effect of stability of the anterior cruciate lig-ament(ACL)-reconstructed knee between lateral meniscus posterior root(LMPRT)repair and partial menis-cectomy.Methods The patients with ACL tear and LMPR injury were enrolled in this study(group A:ACL reconstruction+LMPR repair,17 patients;group B:ACL reconstruction+LMPR partial meniscectomy,10 pa-tients).At the same time,the patients who underwent ACL reconstruction for simple ACL tear were random-ly matched as the control group(group C).All patients had at least 12-month follow-up.Lysholm score and International Knee Documentation Committee(IKDC)score were used to assess the knee function of the pa-tients.The physical examination was assessed using the pivot shift test.Anterior tibial subluxation(ATS),lat-eral meniscal extrusion(LME),Tibial Tubercle-Trochlear Groove(TT-TG)distance,femorotibial rotation(FTR)angle,and the lateral compartment cartilage of the knee were assessed via magnetic resonance imag-ing(MRI).Results A total of 45 patients were enrolled in this study,with 30 males and 15 females,and an average age of(33.98±11.00)years.The follow-up period was(14.54±1.88)months.Compared to the preop-erative measurements,at the latest follow-up,patients in all groups demonstrated significant improvements in Lysholm scores,IKDC scores,ATS,TT-TG,and FTR results(P<0.05).There was a significant difference in the degree of preoperative LME in group A patients compared with the values of the last follow-up(P<0.05).Intergroup comparison:(1)Preoperatively,there were significant differences in Lysholm score,IKDC score,pivot shift test,ATS,and LME in group C compared with groups A and B(P<0.05),and there was no significant difference in TT-TG and FTR in each group(P>0.05).(2)Postoperatively,there was a significant difference in the results of the pivot shift test in group B compared with groups A and C(P<0.05),and there was no significant difference in the results of the pivot shift test between groups A and C(P>0.05).(3)At the last follow-up,there were significant differences in the patient-reported scores and LME in group B com-pared with groups A and C(P<0.05).There was a significant difference between group B and group C in ATS,and there was no significant difference between group A and group C in patient-reported scores,ATS,and LME(P>0.05).There was no significant difference in TT-TG and FTR in each group(P>0.05).Conclu-sions LMPRT repair further improves the anterior and rotational stability of the ACL-reconstructed knee,leading to reduced the LME,and improves the patient-reported scores.