Over the years,several studies demonstrated the crucial role of knee menisci in joint biomechanics.As a result,save the meniscus has become the new imperative nowadays,and more and more studies addressed this topic.Th...Over the years,several studies demonstrated the crucial role of knee menisci in joint biomechanics.As a result,save the meniscus has become the new imperative nowadays,and more and more studies addressed this topic.The huge amount of data on this topic may create confusion in those who want to approach this surgery.The aim of this review is to provide a practical guide for treatment of meniscus tears,including an overview of technical aspects,outcomes in the literature and personal tips.Taking inspiration from a famous movie directed by Sergio Leone in 1966,the authors classified meniscus tears in three categories:The good,the bad and the ugly lesions.The inclusion in each group was determined by the lesion pattern,its biomechanical effects on knee joint,the technical challenge,and prognosis.This classification is not intended to substitute the currently proposed classifications on meniscus tears but aims at offering a readerfriendly narrative review of an otherwise difficult topic.Furthermore,the authors provide a concise premise to deal with some aspects of menisci phylogeny,anatomy and biomechanics.展开更多
BACKGROUND Meniscal sparing surgery is a widely utilised treatment option for unstable meniscal tears with the aim of minimising the risk of progression towards osteoarthritis.However,there is limited data in the lite...BACKGROUND Meniscal sparing surgery is a widely utilised treatment option for unstable meniscal tears with the aim of minimising the risk of progression towards osteoarthritis.However,there is limited data in the literature on meniscal repair outcomes in skeletally immature patients.AIM To evaluate the re-operation rate and functional outcomes of meniscal repairs in children and adolescents.METHODS We performed a retrospective review of all patients who underwent arthroscopic meniscal repair surgery between January 2007 and January 2018.All patients were under the age of 18 at the time of surgery.Procedures were all performed by a single surgeon.Information was gathered from our hospital Electronic Patient Records system.The primary outcome measure was re-operation rate(need for further surgery on the same meniscus).Secondary outcome measures were surgical complications and patient reported outcome measures that were International Knee Documentation Committee(IKDC),Tegner and Lysholm scores.RESULTS We identified 59 patients who underwent 66 All-inside meniscal repairs(32 medial meniscus and 34 Lateral meniscus).Meniscal repairs were performed utilizing FasT-Fix(Smith and Nephew)implants.There were 37 males and 22 females with an average age of 14 years(range 6-16).The average follow-up time was 53 months(range 26-140).Six patients had concomitant anterior cruciate ligament reconstruction surgery along with the meniscal repair.There were no requiring further meniscal repairs and 9 patients underwent partial meniscectomies.The mean postoperative IKDC score was 88(44-100),Tegner score was 7(2-10)and Lysholm score was 94(57-100).CONCLUSION Our results showed that arthroscopic repair of meniscal tears in the paediatric population is an effective treatment option that has a low failure rate and good postoperative clinical with the advantage of preserving meniscal tissues.展开更多
BACKGROUND One of the most important factors to consider in relation to meniscal repair is the high failure rate reported in the existing literature.AIM To evaluate failure rates,return to sports(RTS)rate,clinical out...BACKGROUND One of the most important factors to consider in relation to meniscal repair is the high failure rate reported in the existing literature.AIM To evaluate failure rates,return to sports(RTS)rate,clinical outcomes and magnetic resonance image(MRI)evaluation after meniscus suture repair for longitudinal tears at a minimum 2-year-follow-up.METHODS We conducted a retrospective review of meniscal repairs between January 2004 and December 2018.All patients treated for longitudinal tears associated or not with an anterior cruciate ligament reconstruction(ACL-R)were included.Meniscal ramp lesions,radial and root tears,associated with multiligament injuries,tibial fracture and meniscal allograft transplants were excluded.Surgical details and failure rate,defined as symptomatic patients who underwent a revision surgery,were analyzed.As isolated bucket handle tears(BHTs)were usually associated with higher failure rates,we compared BHTs and not BHTs associated or not with an ACL-R.Since 2014,the inside-out technique using cannulas and suture needles with 2-0 Tycron began to predominate.In addition,the number of stitches per repair was increased.In view of differences in surgical technique,we compared two different cohorts:before and after 2014.We recorded the RTS according to the level achieved and the time to RTS.Lysholm and IKDC scores were recorded.Patients were studied with x-rays and MRI as standard postoperative control.RESULTS One hundred and nineteen patients were included with a mean follow up of 7 years(SD:4.08).Overall failure rate was 20.3%at a mean 20.1 mo.No statistically significant differences were found when comparing failure for medial and lateral meniscal repair(22.7%and 15.3%,P=0.36),BHTs and not BHTs(26%and 17.6%,P=0.27),isolated or associated with an ACL-R(22.9%and 18%,P=0.47),or when comparing only BHTs associated with an ACL-R(23%and 27.7%,P=0.9)or not.When comparing cohorts before and after 2014,we found a significant decrease in the overall failure rate from 26%to 11%(P<0.03).Isolated lesions presented a decrease from 28%to 6.6%(P=0.02),BHTs from 34%to 8%(P=0.09)and those associated with an ACL-R from 25%to 10%(P=0.09).Mean RTS time was 6.5 mo in isolated lesions and 8.64 mo when associated with an ACL-R.Overall,56%of patients returned to the same sport activity level.Mean pre and postoperative Lysholm scores were 64 and 85(P=0.02),and IKDC 58 and 70(P=0.03).Out of 84 asymptomatic patients evaluated with MRI,39%were classified as“not healed”and 61%as“healed”.CONCLUSION Even though the overall failure rate of our series was 20.3%,we found a statistically significant decrease from 26%to 11%,not only for isolated lesions,but also for BHT’s and those associated with an ACL-R when comparing our series in two different cohorts,most probably due to improvements in surgical technique.展开更多
目的:对比半月板成形术与修补缝合术治疗膝关节半月板损伤的效果。方法:回顾性选取2020年5月至2022年5月在本院行关节镜手术的62例膝关节半月板损伤患者,根据其手术方案分为成形术组(n=32,关节镜半月板成形术)和修补缝合术组(n=30,关节...目的:对比半月板成形术与修补缝合术治疗膝关节半月板损伤的效果。方法:回顾性选取2020年5月至2022年5月在本院行关节镜手术的62例膝关节半月板损伤患者,根据其手术方案分为成形术组(n=32,关节镜半月板成形术)和修补缝合术组(n=30,关节镜半月板修补缝合术)。收集两组患者临床资料,观察两组临床疗效。对比两组患者围术期相关指标(手术时间、术中出血量、住院时间),采用膝关节疼痛指数(Visual Analogue Scale,VAS)、Lysholm膝关节评分、美国膝关节协会评分(Knee society score,KSS)及关节活动度(Range of motion,ROM)等评价手术前、术后3 m和6 m的膝关节功能及恢复情况。结果:两组患者临床总有效率比较无差异(93.75%vs 90.00%,P>0.05);修补缝合术组的手术时间长于成形组(P<0.05);两组患者术中出血量及住院时间比较均无差异(P>0.05)。与术前比较,术后两组VAS评分均有下降(P均<0.05),且两组比较无差异(P>0.05)。与术前比较,术后两组患者的Lysholm膝关节评分、KSS及ROM均有明显增高趋势(P均<0.05),且成形术组上述指标均高于修补缝合术组(P<0.05)。结论:关节镜下半月板成形术和半月板缝合修补术治疗膝关节半月板损伤的临床疗效相当;应用成形术术后膝关节功能恢复可能更优。展开更多
目的探讨半月板修复研究的热点和趋势。方法于Web of Science(WOS)核心合集,检索2011年1月1日至2021年12月31日所有半月板修复相关文献,用WOS自带分析功能及Citespace软件对检索结果进行描述性统计、共现、聚类及突现文献分析。结果文...目的探讨半月板修复研究的热点和趋势。方法于Web of Science(WOS)核心合集,检索2011年1月1日至2021年12月31日所有半月板修复相关文献,用WOS自带分析功能及Citespace软件对检索结果进行描述性统计、共现、聚类及突现文献分析。结果文献数量整体呈上升趋势;美国在论文数、引用量、研究机构及资助基金方面均有巨大优势,Smith nephew和Arthrex在此领域资助较多。论文涉及多学科,以临床学科为主。文献共现分析列出引用频次及中心性前10名文献共18篇(其中2篇为重复);聚类分析获得成员>10个的主要聚类7个;绘制聚类共现图谱和时间线图;列出前25篇突现引文。结论半月板修复研究在近11年内呈上升趋势,其中半月板缝合是目前的研究热点,未来在生物打印半月板、组织工程和异体半月板混合物或半月板补片等方面将有更多技术和材料的突破。展开更多
Meniscal allograft transplantation （MAT） may offer .an attractive alternative to restore the normal biomechanical structure of knees. The mean early failure rate （≤2 years） of MAT is approximately 10%.1-3 A succ...Meniscal allograft transplantation （MAT） may offer .an attractive alternative to restore the normal biomechanical structure of knees. The mean early failure rate （≤2 years） of MAT is approximately 10%.1-3 A successful outcome of MAT depends on the ligamentous stability of knee, limb alignment, graft types, and graft fixation methodsY Graft fixations include the meniscal horns and the peripheral rim. Techniques for fixation of the peripheral rim include sutures or a meniscal repair device such as FasT-Fix （Smith ＆ Nephew Inc, Andover, MA, USA）. Here we present an unusual case of early graft failure using FasT-Fix sutured to the peripheral rim of the graft.展开更多
Purpose::To retrospectively analyze the clinical outcomes of meniscus repair with simultaneous anterior cruciate ligament(ACL)reconstruction and explore the causes of failure of meniscus repair.Methods::From May 2013 ...Purpose::To retrospectively analyze the clinical outcomes of meniscus repair with simultaneous anterior cruciate ligament(ACL)reconstruction and explore the causes of failure of meniscus repair.Methods::From May 2013 to July 2018,the clinical data of 165 patients who were treated with meniscus surgery and simultaneous ACL reconstruction,including 69 cases of meniscus repair(repair group)and 96 cases of partial meniscectomy(partial meniscectomy group)were retrospectively analyzed.The exclusion criteria were as follows:(1)ACL rupture associated with fracture,collateral ligament injury,or complex ligament injury;(2)a history of knee surgery;or(3)a significant degree of osteoarthritis.The 69 patients in the repair group were divided into the non-failure group(62 cases)and the failure group(7 cases)depending on the repair effect.Postoperative outcomes of the repair group and the partial meniscectomy group were compared.General conditions and postoperative outcomes of the failure group and the non-failure group were compared.During the median follow-up period of 28 months(range,4-65 months)after the second arthroscopy,postoperative outcomes of seven patients in the failure group were summarized.SPSS 25.0 statistical software was used for statistical analysis.A p value less than 0.05 was considered statistically significant.Results::Seven patients in the failure group who underwent the second arthroscopy were followed up for(30±17.4)months and their postoperative outcomes were summarized.Compared with the partial meniscectomy group,the International Knee Documentation Committee scores of patients in the repair group improved significantly(p=0.031).Compared with the non-failure group,more patients in the failure group were younger than 24 years(p=0.030).The median follow-up period was 39.5 months.All patients recovered well after subsequent partial meniscectomy and relieved clinical symptoms.Visual analog scale scores decreased significantly(p=0.026),and the International Knee Documentation Committee and Lysholm scores improved significantly(p=0.046 for both).Conclusion::The failure rate of meniscus repair in this study was 10.1%(7/69),all of which were medial meniscus tears.However,the surgical outcomes of ACL reconstruction were not affected,and there might be a role for graft protection.Therefore,meniscus retears can be successful treated by performing subsequent partial meniscectomy in patients with repair failure.展开更多
文摘Over the years,several studies demonstrated the crucial role of knee menisci in joint biomechanics.As a result,save the meniscus has become the new imperative nowadays,and more and more studies addressed this topic.The huge amount of data on this topic may create confusion in those who want to approach this surgery.The aim of this review is to provide a practical guide for treatment of meniscus tears,including an overview of technical aspects,outcomes in the literature and personal tips.Taking inspiration from a famous movie directed by Sergio Leone in 1966,the authors classified meniscus tears in three categories:The good,the bad and the ugly lesions.The inclusion in each group was determined by the lesion pattern,its biomechanical effects on knee joint,the technical challenge,and prognosis.This classification is not intended to substitute the currently proposed classifications on meniscus tears but aims at offering a readerfriendly narrative review of an otherwise difficult topic.Furthermore,the authors provide a concise premise to deal with some aspects of menisci phylogeny,anatomy and biomechanics.
文摘BACKGROUND Meniscal sparing surgery is a widely utilised treatment option for unstable meniscal tears with the aim of minimising the risk of progression towards osteoarthritis.However,there is limited data in the literature on meniscal repair outcomes in skeletally immature patients.AIM To evaluate the re-operation rate and functional outcomes of meniscal repairs in children and adolescents.METHODS We performed a retrospective review of all patients who underwent arthroscopic meniscal repair surgery between January 2007 and January 2018.All patients were under the age of 18 at the time of surgery.Procedures were all performed by a single surgeon.Information was gathered from our hospital Electronic Patient Records system.The primary outcome measure was re-operation rate(need for further surgery on the same meniscus).Secondary outcome measures were surgical complications and patient reported outcome measures that were International Knee Documentation Committee(IKDC),Tegner and Lysholm scores.RESULTS We identified 59 patients who underwent 66 All-inside meniscal repairs(32 medial meniscus and 34 Lateral meniscus).Meniscal repairs were performed utilizing FasT-Fix(Smith and Nephew)implants.There were 37 males and 22 females with an average age of 14 years(range 6-16).The average follow-up time was 53 months(range 26-140).Six patients had concomitant anterior cruciate ligament reconstruction surgery along with the meniscal repair.There were no requiring further meniscal repairs and 9 patients underwent partial meniscectomies.The mean postoperative IKDC score was 88(44-100),Tegner score was 7(2-10)and Lysholm score was 94(57-100).CONCLUSION Our results showed that arthroscopic repair of meniscal tears in the paediatric population is an effective treatment option that has a low failure rate and good postoperative clinical with the advantage of preserving meniscal tissues.
文摘BACKGROUND One of the most important factors to consider in relation to meniscal repair is the high failure rate reported in the existing literature.AIM To evaluate failure rates,return to sports(RTS)rate,clinical outcomes and magnetic resonance image(MRI)evaluation after meniscus suture repair for longitudinal tears at a minimum 2-year-follow-up.METHODS We conducted a retrospective review of meniscal repairs between January 2004 and December 2018.All patients treated for longitudinal tears associated or not with an anterior cruciate ligament reconstruction(ACL-R)were included.Meniscal ramp lesions,radial and root tears,associated with multiligament injuries,tibial fracture and meniscal allograft transplants were excluded.Surgical details and failure rate,defined as symptomatic patients who underwent a revision surgery,were analyzed.As isolated bucket handle tears(BHTs)were usually associated with higher failure rates,we compared BHTs and not BHTs associated or not with an ACL-R.Since 2014,the inside-out technique using cannulas and suture needles with 2-0 Tycron began to predominate.In addition,the number of stitches per repair was increased.In view of differences in surgical technique,we compared two different cohorts:before and after 2014.We recorded the RTS according to the level achieved and the time to RTS.Lysholm and IKDC scores were recorded.Patients were studied with x-rays and MRI as standard postoperative control.RESULTS One hundred and nineteen patients were included with a mean follow up of 7 years(SD:4.08).Overall failure rate was 20.3%at a mean 20.1 mo.No statistically significant differences were found when comparing failure for medial and lateral meniscal repair(22.7%and 15.3%,P=0.36),BHTs and not BHTs(26%and 17.6%,P=0.27),isolated or associated with an ACL-R(22.9%and 18%,P=0.47),or when comparing only BHTs associated with an ACL-R(23%and 27.7%,P=0.9)or not.When comparing cohorts before and after 2014,we found a significant decrease in the overall failure rate from 26%to 11%(P<0.03).Isolated lesions presented a decrease from 28%to 6.6%(P=0.02),BHTs from 34%to 8%(P=0.09)and those associated with an ACL-R from 25%to 10%(P=0.09).Mean RTS time was 6.5 mo in isolated lesions and 8.64 mo when associated with an ACL-R.Overall,56%of patients returned to the same sport activity level.Mean pre and postoperative Lysholm scores were 64 and 85(P=0.02),and IKDC 58 and 70(P=0.03).Out of 84 asymptomatic patients evaluated with MRI,39%were classified as“not healed”and 61%as“healed”.CONCLUSION Even though the overall failure rate of our series was 20.3%,we found a statistically significant decrease from 26%to 11%,not only for isolated lesions,but also for BHT’s and those associated with an ACL-R when comparing our series in two different cohorts,most probably due to improvements in surgical technique.
文摘目的:对比半月板成形术与修补缝合术治疗膝关节半月板损伤的效果。方法:回顾性选取2020年5月至2022年5月在本院行关节镜手术的62例膝关节半月板损伤患者,根据其手术方案分为成形术组(n=32,关节镜半月板成形术)和修补缝合术组(n=30,关节镜半月板修补缝合术)。收集两组患者临床资料,观察两组临床疗效。对比两组患者围术期相关指标(手术时间、术中出血量、住院时间),采用膝关节疼痛指数(Visual Analogue Scale,VAS)、Lysholm膝关节评分、美国膝关节协会评分(Knee society score,KSS)及关节活动度(Range of motion,ROM)等评价手术前、术后3 m和6 m的膝关节功能及恢复情况。结果:两组患者临床总有效率比较无差异(93.75%vs 90.00%,P>0.05);修补缝合术组的手术时间长于成形组(P<0.05);两组患者术中出血量及住院时间比较均无差异(P>0.05)。与术前比较,术后两组VAS评分均有下降(P均<0.05),且两组比较无差异(P>0.05)。与术前比较,术后两组患者的Lysholm膝关节评分、KSS及ROM均有明显增高趋势(P均<0.05),且成形术组上述指标均高于修补缝合术组(P<0.05)。结论:关节镜下半月板成形术和半月板缝合修补术治疗膝关节半月板损伤的临床疗效相当;应用成形术术后膝关节功能恢复可能更优。
文摘目的探讨半月板修复研究的热点和趋势。方法于Web of Science(WOS)核心合集,检索2011年1月1日至2021年12月31日所有半月板修复相关文献,用WOS自带分析功能及Citespace软件对检索结果进行描述性统计、共现、聚类及突现文献分析。结果文献数量整体呈上升趋势;美国在论文数、引用量、研究机构及资助基金方面均有巨大优势,Smith nephew和Arthrex在此领域资助较多。论文涉及多学科,以临床学科为主。文献共现分析列出引用频次及中心性前10名文献共18篇(其中2篇为重复);聚类分析获得成员>10个的主要聚类7个;绘制聚类共现图谱和时间线图;列出前25篇突现引文。结论半月板修复研究在近11年内呈上升趋势,其中半月板缝合是目前的研究热点,未来在生物打印半月板、组织工程和异体半月板混合物或半月板补片等方面将有更多技术和材料的突破。
文摘Meniscal allograft transplantation （MAT） may offer .an attractive alternative to restore the normal biomechanical structure of knees. The mean early failure rate （≤2 years） of MAT is approximately 10%.1-3 A successful outcome of MAT depends on the ligamentous stability of knee, limb alignment, graft types, and graft fixation methodsY Graft fixations include the meniscal horns and the peripheral rim. Techniques for fixation of the peripheral rim include sutures or a meniscal repair device such as FasT-Fix （Smith ＆ Nephew Inc, Andover, MA, USA）. Here we present an unusual case of early graft failure using FasT-Fix sutured to the peripheral rim of the graft.
基金This study was supported by Integrated application of technol-ogy and comprehensive demonstration Project of Scientific and Technological Winter Olympics of Zhangjiakou in 2020(20110004D)It was supported by Integrated application of technology and comprehensive demonstration Project of Scientific and Technological Winter Olympics of Zhangjiakou in 2021(21110006D)It was supported by 2019(2019YFF0302305)Nation Key Research and Development Program for"Science and Technology Winter Olympics"of China.It was also supported by the scientific research fund of Peking University Health Science Center,BMU2018MX030.
文摘Purpose::To retrospectively analyze the clinical outcomes of meniscus repair with simultaneous anterior cruciate ligament(ACL)reconstruction and explore the causes of failure of meniscus repair.Methods::From May 2013 to July 2018,the clinical data of 165 patients who were treated with meniscus surgery and simultaneous ACL reconstruction,including 69 cases of meniscus repair(repair group)and 96 cases of partial meniscectomy(partial meniscectomy group)were retrospectively analyzed.The exclusion criteria were as follows:(1)ACL rupture associated with fracture,collateral ligament injury,or complex ligament injury;(2)a history of knee surgery;or(3)a significant degree of osteoarthritis.The 69 patients in the repair group were divided into the non-failure group(62 cases)and the failure group(7 cases)depending on the repair effect.Postoperative outcomes of the repair group and the partial meniscectomy group were compared.General conditions and postoperative outcomes of the failure group and the non-failure group were compared.During the median follow-up period of 28 months(range,4-65 months)after the second arthroscopy,postoperative outcomes of seven patients in the failure group were summarized.SPSS 25.0 statistical software was used for statistical analysis.A p value less than 0.05 was considered statistically significant.Results::Seven patients in the failure group who underwent the second arthroscopy were followed up for(30±17.4)months and their postoperative outcomes were summarized.Compared with the partial meniscectomy group,the International Knee Documentation Committee scores of patients in the repair group improved significantly(p=0.031).Compared with the non-failure group,more patients in the failure group were younger than 24 years(p=0.030).The median follow-up period was 39.5 months.All patients recovered well after subsequent partial meniscectomy and relieved clinical symptoms.Visual analog scale scores decreased significantly(p=0.026),and the International Knee Documentation Committee and Lysholm scores improved significantly(p=0.046 for both).Conclusion::The failure rate of meniscus repair in this study was 10.1%(7/69),all of which were medial meniscus tears.However,the surgical outcomes of ACL reconstruction were not affected,and there might be a role for graft protection.Therefore,meniscus retears can be successful treated by performing subsequent partial meniscectomy in patients with repair failure.
