膝关节内外侧半月板后根部撕裂的MRI诊断价值

目的:探讨MRI对膝关节内外侧半月板后根部撕裂的诊断价值。方法:回顾性分析2012年1月至2016年1月,关节镜下证实为半月板后根部撕裂的患者43例。其中男25例,女18例;年龄27~69(42.5±8.3)岁;右侧27例,左侧16例。由2名医师采用双盲法独立回顾性分析经关节镜证实的43例半月板后根部撕裂患者的MRI表现,计算MRI对半月板后根部撕裂的诊断敏感性、特异性和准确性,并计算膝关节韧带损伤及半月板脱位等伴随情况。结果:143例中,关节镜手术证实43例半月板后根部撕裂,包括内侧撕裂24例,外侧撕裂19例。医师A诊断内侧半月板后根部撕裂的敏感性、特异性、准确性分别为91.67%、86.6%、83.9%,伴内侧半月板突出19例,伴前交叉韧带撕裂2例;外侧半月板后跟部撕裂的敏感性、特异性、准确性分别为73.7%、79.9%、79%,伴外侧半月板突出4例,伴前交叉韧带撕裂16例。医师B诊断内侧半月板后根部撕裂的敏感性、特异性、准确性分别为87.5%、87.4%、87.4%,伴内侧半月板突出19例,伴前交叉韧带撕裂2例;外侧半月板后跟部撕裂的敏感性、特异性、准确性分别为78.9%、82.3%、82.5%,伴外侧半月板突出4例,伴前交叉韧带撕裂16例。2名医师采用MRI诊断内、外侧半月板后根部撕裂的一致性均好,Kappa值分别为0.81和0.67。结论 :膝关节MRI诊断内外侧半月板后跟部撕裂及其伴随征象具有较大价值,为临床医生术前诊断提供依据,值得临床推广应用。     

应用可吸收缝线修复膝关节半月板损伤

自 1996年以来 ,我们采用可吸收的缝合线 ,修复治疗半月板损伤 16例 ,疗效满意。报告如下 :1　临床资料1 1　一般资料　本组 16例病人中 ,男 13例 ,女 3例 ;年龄17～ 48岁 ,平均 2 6岁。内侧半月板损伤 7例 ,外侧半月板损伤 9例 ,合并膝关节内骨折和交叉韧带损伤 4例。损伤部位 :前角撕裂 7例 ,后角撕裂 3例 ,体部撕裂 6例 ,其中体部纵形撕裂 2例 ,横形撕裂 4例。 16例除 4例合并膝关节内骨折和交叉韧带损伤手术中发现确诊外 ,其余 12例均通过ＧＪ- 2型关节镜和关节造影确诊。1 2　手术方法　手术采用硬膜外麻醉或腰麻。于大腿上段缚气囊止…     

关节镜下半月板水平撕裂的保全治疗

2008年2月～2009年4月,笔者对11例膝关节半月板水平撕裂患者经关节镜行半月板撕裂部分切除保全术,效果满意. 1 材料与方法 1.1 病例资料本组11例,男9例,女2例,年龄36～62(47±14)岁.左膝1例,右膝10例.均经MRI确诊为关节积液并半月板水平撕裂损伤.膝关节半月板水平撕裂的MRI分级标准[1]:Ⅰ级3例,Ⅱ级8例.内侧半月板损伤8例,外侧半月板损伤3例,均为后角损伤,其中隐性水平撕裂4例.1例合并前交叉韧带(ACL)断裂,2例骨性关节炎.     

关节镜下复位缝合富血小板血浆注射治疗陈旧性半月板桶柄样撕裂

[目的]介绍陈旧性内侧半月板桶柄样撕裂镜下复位缝合修复,结合富血小板血浆注射的手术技术与初步结果。[方法]对1例28岁陈旧性内侧半月板桶柄样撕裂23年的患者行镜下复位缝合,同时行富血小板血浆注射。镜下全面探查关节内病变,将半月板撕裂部和关节囊残缘打磨出新鲜创面,采用由内向外"U"形缝合半月板2针,牵拉关节外侧缝线,在关节镜直视下松解半月板前、后角挛缩部分,使半月板桶柄撕裂缘与关节囊缘逐渐靠拢,将缝线打结固定。再采用Fast-fix 360将半月板体部至后角撕裂部分全内缝合。探查半月板缝合后撕裂部分复位满意,稳定性良好。将制备好的PRP共4 ml沿内侧膝关节间隙半月板的体部及后角等部位,多点穿刺注射。[结果]术后患者疼痛和关节交锁等症状消失,逐步恢复伤膝活动。术后2个月,患者恢复运动能力,无明显不适,复查MRI显示左膝内侧半月板形态完整、均质,无明显异常信号。[结论]对陈旧性内侧半月板桶柄样撕裂进行适当松解仍可缝合修复,富血小板血浆注射有利于陈旧性半月板缝合修复后愈合。     

半月板撕裂和切除对前交叉韧带断裂力学稳定性的影响

目的探讨半月板对前交叉韧带断裂及重建术后胫骨前向稳定性的影响。 方法收集2017年1月至2018年10月期间前交叉韧带重建患者,排除前交叉韧带部分断裂和多发韧带损伤病例。所有不稳定半月板撕裂均行半月板部分切除术,根据半月板损伤部位及程度进行分组。采用KT-1000测量术前、术后3个月和6个月的胫骨前平移量(ATT)。组间对照采用独立样本t检验。 结果共纳入158例前交叉韧带断裂患者,其中半月板正常组61例,内侧半月板后角撕裂组49例(19例为撕脱<总宽度40%;30例为撕脱≥总宽度40%);外侧半月板撕裂组35例(12例为撕脱<总宽度40%;23例为撕脱≥总宽度40%);内侧半月板前角或体部撕裂组13例(6例为撕脱<总宽度40%;7例为撕脱≥总宽度40%)。术前内侧半月板后角撕裂≥总宽度40%患者的胫骨前平移量较半月板正常患者明显增加,差异有统计学意义(t＝12.141,P<0.01)。术后3个月及6个月,各个半月板撕裂组的ATT值与半月板正常患者相比均无差异(P >0.05)。 结论内侧半月板后角撕裂与前交叉韧带断裂可增加膝关节的不稳定性,半月板部分切除术对前交叉韧带重建术后患者的膝关节稳定性无影响。     

关节镜外侧半月板下入路技术用于外侧半月板前角层裂下层的切除

目的探讨关节镜外侧半月板下入路切除外侧半月板前角下层的效果。方法 2008年1月～2010年12月,对10例外侧半月板前角层裂采用关节镜外侧半月板下入路切除外侧半月板前角层裂中不稳定的下层。采用3个入路：膝前外侧入路,前内侧入路及外侧半月板下入路。自前内侧入路置入关节镜观察;经前外侧入路使用探沟翻转层裂上层,并尽可能显露下层;经外侧半月板下入路使用直头Punch（篮钳）切除半月板前角层裂的下层。结果无术后并发症。6例术后MRI检查均显示半月板前角下层完全切除。10例随访12～45个月,平均18.9月：9例膝关节完全不痛,1例偶尔运动后疼痛;10例膝关节活动范围均恢复至正常;膝关节Lysholm评分由术前（68.7±12.9）分提高到术后随访时的（94.4±5.7）分（配对t检验,t=7.79,P=0.00）。结论关节镜外侧半月板下入路可安全、有效切除外侧半月板前角层裂中不稳定的下层。     

膝关节内侧半月板前角罕见异常插入点的关节镜、组织学及影像学观察

目的:探讨膝关节内侧半月板前角罕见异常插入点的关节镜、影像学及组织学特征。方法:2018年1月至2021年4月,于6 500余例膝关节镜手术中发现7例半月板撕裂患者的膝关节内侧半月板前角与前十字韧带之间有罕见的异常插入（前内板股韧带）,男4例、女3例;年龄（37.85±7.70）岁（范围27~50岁）。疾病诊断为内侧半...     

儿童及青少年膝关节MRI检查的意义

儿童及青少年膝关节疾病诊断常常比较困难,由于生长期结构的变化以及目前缺少对MRI精确的描述,MRI检查对儿童及青少年膝关节疾病诊断的价值受到质疑。作者对96例儿童及青少年膝关节疾病进行前瞻性研究。分析6种主要诊断:前叉韧带撕裂、外侧半月板撕裂、内侧半月板撕裂、分离性骨炎、外侧盘状半月板和骨软骨骨折。所有病例均接受同一位医生的关节镜治疗。结果发现MRI检查明显提高对儿童及青少年膝关节前叉韧带撕裂、外侧半月板撕裂、分离性骨炎和外侧盘状半月板4种疾病的诊断率。儿童及青少年膝关节MRI检查的意义@胡孔足     

关节镜下建立髁间窝通道治疗内侧半月板后角复杂破裂

目的 :探讨在关节镜下建立髁间窝通道并经该通道治疗内侧半月板后角复杂破裂。方法 :对127例经过髁间窝通道施行了半月板部分切除成形术的骨关节炎病例进行分析总结。127例患者均存在内侧半月板后角复杂裂,男24例,女103例;年龄45~78岁,平均67岁;127例中有112例通过3切口(常规前内侧切口、前外侧切口、高位前外侧切口)顺利完成内侧半月板后角部分切除成形术,有15例通过4切口(常规前内侧切口、前外侧切口、高位前外侧切口、后内侧切口)来完成手术。从4个方面进行评价:该方法对半月板后角部位能否全面便利观察、器械能否便利抵达靶部位、对相邻关节软骨的损伤情况和手术时间(处理半月板的时间)。结果:所有病例的半月板后角后根都能被全面清晰观察,器械都能便利地抵达靶部位,无软骨的医源性破坏发生,3切口情况下内侧半月板后角部位部分切除成形术的时间为5~10 min,4切口的时间为10~30 min。结论:在关节镜下建立髁间窝通道并经此通道治疗内侧半月板后角复杂破裂,方便快捷,最大程度减少了对关节软骨的医源性损伤。     

膝关节自发性骨坏死与内侧半月板突出相关性的MRI观察

[目的]分析内侧半月板突出与膝关节自发性骨坏死的相关性,同时探讨内侧半月板后角根部撕裂(MMRT)对内侧半月板突出长度、骨坏死体积的影响。[方法]选取本院2011年1月~2014年12月诊断膝关节自发性骨坏死的17例患者,根据MRI上所测量的内侧半月板突出长度分为两组,突出长度≥3 mm者为半脱位组,3mm则为对照组,对比两组间骨坏死体积;同时分析突出长度与骨坏死体积之间的相关性;根据MRI上是否存在内侧半月板后角根部撕裂,将患者分为撕裂组(MMRT组)和对照组,对比两组间内侧半月板突出长度以及骨坏死体积。[结果]17例患者中有16例(94.1%)存在不同程度的内侧半月板突出,其中9例(52.9%)为内侧半月板半脱位,半脱位组的骨坏死体积显著大于对照组(P=0.004),且内侧半月板突出长度与骨坏死体积之间呈正相关(r=0.845,P=0.000)。同时发现有7例(42.1%)患者伴有内侧半月板后角根部撕裂,撕裂组(MMRT组)的内侧半月板突出长度和骨坏死体积均大于对照组,但差异无统计学意义(P值分别为0.315、0.088)。[结论]内侧半月板突出和半脱位在膝关节自发性骨坏死患者中发生率高,而且突出长度与骨坏死体积呈正相关,这一现象支持膝关节自发性骨坏死病因学中的应力源性理论。导致严重内侧半月板突出的因素可能是多方面的,不仅仅是内侧半月板后角根部撕裂。     

Die arthroskopische Meniskusrefixation mit einem All-inside-Nahtsystem

OBJECTIVE: Application of an arthroscopic suture system to restore the form and function of the meniscus by adaptation of a longitudinal tear close to the base. INDICATIONS: Unstable longitudinal tears near the base of the meniscus, mainly in the posterior horn of the medial or lateral of the meniscus. Dislocated bucket-handle tears of the medial and lateral meniscus close to the base. CONTRAINDICATIONS: Poor tissue quality with fibrillated meniscal tissue. Meniscal tears in the avascular zone (zone I). Insufficient blood supply from the joint capsule and the base of the meniscus. Degenerative meniscal lesions. Anterior or posterior knee joint instability. Allergic reactions to nonresorbable suture material. SURGICAL TECHNIQUE: Standard anterior arthroscopic portals. Arthroscopic assessment of the meniscal tear using the probe. Revitalization of the tear margins and perforation of the meniscal base to induce bleeding. Adaptation of the tear margins and fixation with a suture-anchor system using an ipsilateral standard portal for tears in the posterior horn or by way of a contralateral standard portal for tears in the lateral horn. POSTOPERATIVE MANAGEMENT: Full weight bearing with the knee in extension in a knee immobilizer, relative to the pain threshold in the 1st postoperative week. Range of motion exercises without weight bearing from full extension to 90 degrees knee flexion (0/0/90). If simultaneous reconstruction of the anterior cruciate ligament (ACL) is being performed, rehabilitation protocols follow the principles for ACL reconstruction. RESULTS: Since the year 2000, meniscal tears in more than 300 patients have been repaired with the all-inside suture system. In the context of a multicenter study by ESSKA (European Society for Sports Medicine, Surgery and Arthroscopy) involving 20 patients, the result was evaluated by direct MRI arthrography (gadolinium). The suture bar anchors were generally not detectable, the incision channels produced a hypodense signal in the meniscus tissue. If re-rupture occurred, it was because the meniscus had pulled out of the suture loop. Cartilaginous lesions were not found. There were no complications related to the nonresorbable suture bar anchors.     

Altered signal intensity in the posterior horn of the medial meniscus: an MR finding of questionable significance

Introduction MR imaging has emerged as an important modality in the non-invasive evaluation of osseous and soft-tissue structures in the post-traumatic knee. However, it is sometimes impossible to determine with confidence if a focus of high signal intensity in the meniscus is confined to the substance of the meniscus or if it extends to involve the joint surface. This is a critical differentiation because the latter represents meniscal tears that can be found and treated arthroscopically, whereas the former represents degeneration, intrasubstance tears or perhaps normal variants that are not amenable to arthroscopic intervention. The aim of this study was to investigate the occurrence of such borderline findings in relation to the posterior horn of the medial meniscus and to correlate the arthroscopic results.Materials and methods Sixty-four patients with suspected post-traumatic internal derangements of the knee who underwent MR imaging prior to arthroscopy were evaluated retrospectively. There were 48 men and 16 women. Their mean age was 28.2 years.Results Tears of the posterior horn of the medial meniscus were diagnosed unequivocally (grade 3 signal) in 18 patients and equivocally (grade 2/3 signal) in 10 patients. Arthroscopic correlation revealed 16 tears (89%) in the unequivocal group and only 1 tear (10%) in the equivocal group.Conclusion A meniscal tear is unlikely when MR shows a focus of high signal intensity in the posterior horn of the medial meniscus that does not unequivocally extend to involve the inferior or superior joint surface. An appropriate trial of conservative treatment is recommended in such questionable cases. MR is a useful diagnostic tool—however, it should be used selectively, and in conjunction with history and clinical examination in evaluating internal derangements of the knee.     

Snapping knee caused by a popliteomeniscal fascicle tear of the lateral meniscus in a professional Taekwondo athlete

A 19-year-old male professional Taekwondo athlete presented with a 2-year history of pain-free snapping of his right knee. He reported that his right knee joint gave way during games and training and that he could induce pain-free snapping between the proximal-to-fibular head and the lateral knee joint line. None of these physical findings suggested a meniscal pathology or ligamentous instability. Routine radiographs were normal. Magnetic resonance imaging of his right knee joint showed that the shape of the lateral meniscus was normal, and no lateral meniscus tears existed. On arthroscopic examination, popliteal hiatus view showed a posterosuperior popliteomeniscal fascicle tear between the posterior horn of the lateral meniscus and the posterior joint capsule just posteromedial to the popliteus tendon. With medial traction by probing, this popliteomeniscal tear made visible the significant subluxation of the posterior horn of the lateral meniscus to the center or anterior half of the tibial plateau. Based on the diagnosis of a posterosuperior popliteomeniscal tear of the right knee, Fast-Fix (Smith & Nephew, Andover, Massachusetts) was used for the direct repair of the peripheral portion of the lateral meniscus and joint capsule, targeting the popliteomeniscal junction. At 24 months postoperatively, the patient was performing athletic exercises relevant to his profession and was taking part in Taekwondo games, with no pain or recurrence of snapping. To the authors' knowledge, this is the first report of snapping of the lateral aspect of the knee due to a popliteomeniscal fascicle tear.     

Repair of meniscal tears with the absorbable Clearfix screw: results after 1–3 years

Introduction Total meniscus resection usually leads to osteoarthritis of the knee joint. Preservation and refixation of the injured menisci are therefore of great clinical importance.Materials and methods The present study examines 40 meniscal injuries in 37 patients that were arthroscopically treated with Clearfix meniscal screws (Mitek, Norderstedt, Germany) in the period from August 1999 to December 2002. The mean patient age was 27.7 (range 16–62) years. Nine patients were female. A total of 24 patients (27 meniscal tears) also had an anterior cruciate ligament (ACL) lesion, and 5 patients had cartilage injuries. Twenty-two patients were treated within the first 2 weeks following the trauma, 10 patients within 8 weeks, and 5 patients after 8 weeks. The lesions were a bucket-handle tear of the medial meniscus in 11 cases and a bucket-handle tear of the lateral meniscus in 2 cases. The posterior horn of the medial meniscus was torn in 13 cases, and the pars intermedia in 3 cases. The posterior horn of the lateral meniscus was torn in 8 cases, and the pars intermedia in 3 cases. The mean tear length was 2.9 (±1.5) cm and was fixed with an average of 1.8 (±0.7) screws. In 7 cases, the anterior horn was treated with an additional meniscal suture. A total of 35 patients were examined after an average of 18 (range 7–45) months.Results In the event of a moderate outcome, MRI was performed as part of the follow-up investigation. The average Lysholm score was 93 (±7.4), the Tegner activity index was 6.3 (±2.0) before the accident and 5.8 (±2.0) at the follow-up, the Marshall knee score was 47 (±3.8). The VAS pain assessment was 1.6 (±1.3) and the VAS function assessment was 7.9 (±1.6). Of the 7 patients with a moderate result, 2 patients without additional ligament lesions suffered re-ruptures after 6 and 13 months, respectively. The other 5 patients with a moderate result each had multiple accompanying injuries or pre-existing damage to the affected knee joint.Conclusion The Clearfix screws achieved a clinical success rate of 82% in isolated meniscal tears in stable knee joints and a clinical success rate of 100% with additional ACL reconstruction. In view of the good clinical results and the simple procedure for use, the implant should be recommended for meniscal refixation.     

Posterior root tear fixation of the lateral meniscus combined with arthroscopic ACL double-bundle reconstruction: technical note of a transosseous fixation using the tibial PL tunnel

According to our observation in ACL reconstruction, we find root tears of the posterior horn of the lateral meniscus as a common concomitant injury in ACL-deficient knees. This might be a consequence of initial trauma or of the increased anterior–posterior translation of the tibia and an overload impact on the posterior meniscus root in ACL-deficient knees. A tear of the posterior horn of the medial meniscus causes a 25% increase in peak pressure in the medial compartment compared with that found in the intact condition. The repair restores the peak contact pressure to normal (Allaire et al. in J Bone Joint Surg Am 90(9):1922–1931, [2008]). A tear of the posterior horn of the lateral meniscus might have similar consequences. We hypothesize the surgical anatomical reattachment of the root at the tibia helping to restore knee joint kinematics and helping to advance ACL-graft function. This article presents an arthroscopical technique to reattach the posterior meniscus root in combination with ACL double-bundle reconstruction. The procedure uses the tibial PL tunnel to fix the meniscus suture.     

The effect of complete radial lateral meniscus posterior root tear on the knee contact mechanics: a finite element analysis

Background

In recent years, with technological advances in arthroscopy and magnetic resonance imaging and improved biomechanical studies of the meniscus, there has been some progress in the diagnosis and treatment of injuries to the roots of the meniscus. However, the biomechanical effect of posterior lateral meniscus root tears on the knee has not yet become clear. The purpose of this study was to determine the effect of a complete radial posterior lateral meniscus root tear on the knee contact mechanics and the function of the posterior meniscofemoral ligament on the knee with tear in the posterior root of lateral meniscus.

Methods

A finite element model of the knee was developed to simulate different cases for intact knee, a complete radial posterior lateral meniscus root tear, a complete radial posterior lateral meniscus root tear with posterior meniscofemoral ligament deficiency, and total meniscectomy of the lateral meniscus. A compressive load of 1000 N was applied in all cases to calculate contact areas, contact pressure, and meniscal displacements.

Results

The complete radial posterior lateral meniscus root tear decreased the contact area and increased the contact pressure on the lateral compartment under compressive load. We also found a decreased contact area and increased contact pressure in the medial compartment, but it was not obvious compared to the lateral compartment. The lateral meniscus was radially displaced by compressive load after a complete radial posterior lateral meniscus root tear, and the displacement took place mainly in the body and posterior horn of lateral meniscus. There were further decrease in contact area and increases in contact pressure and raidial displacement of the lateral meniscus in the case of the complete posterior lateral meniscus root tear in combination with posterior meniscofemoral ligament deficiency.

Conclusions

Complete radial posterior lateral meniscus root tear is not functionally equivalent to total meniscectomy. The posterior root torn lateral meniscus continues to provide some load transmission and distribution functions across the joint. The posterior meniscofemoral ligament prevents excessive radial displacement of the posterior root torn lateral meniscus and assists the torn lateral meniscus in transmitting a certain amount of stress in the lateral compartment.     

Arthroscopic partial meniscectomy of a posteriorly flipped superior leaflet in a horizontal medial meniscus tear using a posterior transseptal portal

This article describes a case of an arthroscopic partial meniscectomy of a posteriorly flipped superior leaflet in a horizontal medial meniscus tear using the posterior transseptal portal. An arthroscopic partial meniscectomy for bucket handle or flap tears in medial or lateral compartments using ordinary portals is a relatively common procedure in irreparable cases. However, the posterior compartment of the knee is not readily accessible through ordinary arthroscopic portals. Therefore, it has been considered a blind spot. Through the posterior transseptal portal, surgeons can achieve excellent arthroscopic visualization of the posterior compartment and easily perform arthroscopic procedures of the posterior compartment of the knee. A 48-year-old woman presented with a 1-year history of pain in the medial aspect of the right knee joint. Preoperative magnetic resonance imaging revealed a thinning of the medial meniscus posterior horn in coronal images and a sharp-edged triangle arising from the medial meniscus posterior horn between the medial femoral condyle and medial meniscus posterior horn on sagittal images (flipped-over sign). During the arthroscopic procedure, we found that the flipped leaflet was displaced posteriorly and was not mobile between the medial femoral condyle and medial meniscus posterior horn. Partial meniscectomy for a posteriorly displaced fragment can be performed successfully using the posterior transseptal portal. The posterior transseptal portal is useful for an arthroscopic partial meniscectomy of a posteriorly flipped leaflet in the posterior compartment of the knee.     

Clinical features of the posterior horn tear in the medial meniscus

Introduction A lower threshold of suspicion is necessary for the appropriate diagnosis of a posterior horn tear in the medial meniscus. In these cases, radial tears or meniscus detachment from its insertion follow minor trauma and precipitate severe knee pain in middle-aged and elderly patients. The purpose of this paper is to demonstrate the key points for diagnosis through examination of the clinical features of this tear.Materials and methods Arthroscopic examination of 250 knees with medial meniscus tears (and no ligamentous injuries; over 40 years old) identified 26 knees (26 tears) with a posterior horn tear. Of these 26 tears, 16 were radial, and 10 were detached.Results Eighty-five percent of patients could recall discrete events that preceded the pain. They described these events as a click or a feeling of shock. Afterwards, most patients complained of severe pain or giving way. Hydrarthrosis involving more than 5 ml was present in 81%. Most radiographs (92%) appeared nearly normal.Conclusion It is important to note that this type of tear of the posterior horn in the medial meniscus is not rare. Because this area is difficult to visualize arthroscopically, it may be overlooked unless the threshold of suspicion is lowered.No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.