内侧半月板后角放射状撕裂与水平撕裂的危险因素分析

 目的 比较内侧半月板后角放射状撕裂和水平撕裂的危险因素。方法 回顾性分析2011年1月至2012年12月收治的390例应用关节镜治疗的内侧半月板撕裂患者的临床资料,选取其中94例内侧半月板后角放射状撕裂患者及95例内侧半月板后角水平撕裂患者作为研究对象。记录并比较内侧半月板后角放射状撕裂与内侧半月板后角水平撕裂两组患者的年龄、性别、症状持续时间、体重指数、外伤史、胫骨后倾角、膝关节外翻角及Outerbridge软骨分级。采用多因素非条件Logistic回归分析半月板放射状撕裂的危险因素。结果 半月板后角水平撕裂和放射撕裂患者的性别（χ²=9.059,P=0.003）、体重指数（t=-2.549,P=0.012）、膝关节外翻角（t=-5.609,P=0.000）及软骨分级（χ²=42.300,P=0.000）的差异有统计学意义,而外伤史（χ²=0.368,P=0.544）、胫骨后倾角（χ²=1.021,P=0.312）、年龄（t=-1.228,P=0.221）及症状持续时间（t=0.272,P=0.786）的差异无统计学意义。多因素分析结果显示外翻角（Or=12.581,P=0.001）、年龄（Or=0.875,P=0.026）及Outerbridge软骨分级Ⅰ~Ⅳ级（Or=33.790、15.558、39.891、91.041,P=0.000）为半月板放射状撕裂的危险因素。结论 半月板后角撕裂在老年骨关节炎患者中的发生率较高,内侧半月板后角放射状撕裂与水平撕裂比较,更容易发生在膝关节内翻、软骨退变严重的老年患者中。     

双膝关节内侧盘状半月板1例报道及文献回顾

正患儿,女,7岁,因双侧膝关节疼痛1年,加重1周于2013年12月26日收入院。患者1年前无明显诱因出现双膝关节疼痛,左侧重于右侧,未做系统治疗,疼痛间歇性加重。近1周疼痛加重遂来我院就诊,平素身体健康,无外伤手术史。入院后查体:双侧膝关节略肿胀,轻度外翻。膝关节内侧间隙压痛阳     

Tibiofemoral contact mechanics following a horizontal cleavage lesion in the posterior horn of the medial meniscus

The purpose of this study was to determine if a horizontal cleavage lesion (HCL) of the posterior horn of the medial meniscus would result in changes to tibiofemoral contact mechanics, as measured by peak contact pressure and contact area, which can lead to cartilage degeneration. To study this, 10 cadaveric knees were tested in a rig where forces were applied (500 N Compression, 100 N shear, 2.5 Nm Torque) and the knee dynamically flexed from ?5° to 135°, as peak contact pressure and contact area were recorded. After testing of the intact knee, a horizontal cleavage lesion was created arthroscopically and testing repeated. The Wilcoxon signed‐rank test was used to determine if there were differences in peak contact pressure and contact area between the intact knee and that with the HCL. A statistically significant increase in peak contact pressure of 13%, on average, and a decrease in contact area of 6%, on average, was noted following the HCL. This suggests that a horizontal cleavage lesion will result in small but statistically significant changes in tibiofemoral contact mechanics which may lead to cartilage degeneration. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 33:584–590, 2015.

     

Acute bucket-handle tear of the medial meniscus in a golfer

This is the first case report of an acute bucket-handle tear in an amateur golfer. The injury occurred during the follow-through phase of the golf swing. The rate of incidence of knee injuries in golfers is only 10%. There is a difference in the injury pattern between amateur and professional golfers; amateurs are more likely to sustain injuries related to poor swing technique. Professional golfers, on the other hand, report more injuries related to overuse. Although forces in the knee are relatively minor in this sport, acute injuries can happen when poor technique is used.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 17, No 6 (July-August), 2001: E25     

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.     

Radial tears associated with cleavage tears of the medial meniscus in athletes

Purpose: To evaluate the significance of a small radial tear in the root of the posterior horn of the medial meniscus in an otherwise normal-looking meniscus in individuals who play vigorous sports. Type of Study: Retrospective review. Methods: Arthroscopy was performed in 1,270 patients; 11 patients (0.86%) had a small radial tear in the root of the medial meniscus. Trimming of the tear revealed a large horizontal cleavage tear of the posterior horn and body of the meniscus. The average age of the affected patients was 29.6 years (range, 21 to 45 years), and all were active in sports. Magnetic resonance imaging was of dubious diagnostic value. Three patients had undergone previous arthroscopy at which time the small radial root tear had been noted but was not thought to warrant treatment. Results: All 11 patients returned to their former levels of activity after adequate surgery. Conclusions: When a radial root tear in the medial meniscus is found in an athletic patient, the edges of the tear should be trimmed, the root of the medial meniscus examined, and any additional torn cartilage resected.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 18, No 3 (March), 2002: pp 254–256     

Bucket-handle tear of the medial meniscus. A case for conservative surgery.

To compare the results of two methods of treatment for bucket-handle tears of the medial meniscus eighty-seven knees were studied, thirty-seven treated by excision of the bucket-handle tear alone and fifty by total meniscectomy. A postoperative history suggestive of locking was given by one patient in each treatment group. Anteroposterior laxity was found in 72% of knees treated by excision of the bucket-handle tear alone as compared with 68% of the knees treated by total meniscectomy, but in all other respects the results showed a marginal preference in favor of the simpler operation. Although the numbers are too small to prove that results are better following excision of the bucket-handle tear alone, it is suggested, in the absence of evidence that total meniscectomy is more advantageous, that the simpler operation of excision of just the bucket-handle tear is the treatment of choice in bucket-handle tears of the medial meniscus.     

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。     

A giraffe neck sign of the medial meniscus: A characteristic finding of the medial meniscus posterior root tear on magnetic resonance imaging

Background

The posterior root ligament of the medial meniscus (MM) has a critical role in regulating the MM movement. An accurate diagnosis of the MM posterior root tear (MMPRT) using magnetic resonance imaging (MRI) is important for preventing sequential osteoarthritis following the MMPRT. However, diagnosis of the MMPRT is relatively difficult even after using several characteristic MRI findings. The aim of this study was to identify a useful meniscal body sign of the MMPRT for improving diagnostic MRI reading.

A repair technique using two simple stitches reduces the short-term postoperative medial meniscus extrusion after pullout repair for medial meniscus posterior root tear

European Journal of Orthopaedic Surgery & Traumatology - Two types of repair techniques, FasT-Fix modified Mason–Allen (F-MMA) and two simple stitches (TSS), for the treatment of a medial...     

Role of the mechanical axis of lower limb and body weight in the horizontal tear and root ligament tear of the posterior horn of the medial meniscus

Purpose

To compare and analyse the relationship between horizontal tear and root ligament tear of the posterior horn of the medial meniscus (PHMM) and the degree of varus in the axis of lower limb and body weight.

Methods

One hundred and nineteen patients underwent surgical treatment as they were diagnosed with medial meniscus tear in our hospital from May 2006 to December 2009. Of these, 19 cases (group 1), underwent partial meniscectomy as they were confirmed to solely have horizontal tear of the PHMM on arthroscopic examination and 27 cases (group 2), underwent subtotal meniscectomy as they were confirmed to solely have root ligament tear of the PHMM on arthroscopic examination, were chosen for retrospective study. Standing radiographs were taken of every case prior to arthroscopic surgery to measure varus angle. Also, we checked body mass index (BMI) of two groups. The difference of varus angle and BMI between two groups were statistically verified using the Levene’s test, paired t-test.

Results

Group 1 showed mean value of varus angle of 2.30 ± 0.54, and BMI of 25.32 ± 3.23. Group 2 showed mean value of varus angle of 5.64 ± 0.54, and BMI of 25.67 ± 3.12. The degree of varus of group 2 was statistically significantly higher than group 1 (p = 0.002). Comparison between the BMI of two groups showed no statistical significance (p = 0.053).

Conclusion

Through a comparative study of sole horizontal tear and root ligament tear of the PHMM, the authors have found that sole root ligament tear of the PHMM is more relative to the genu varum than sole horizontal tear of the PHMM. However, body weight was statistically irrelevant to the incidence of the two lesions.     

Bucket handle tear of a discoid medial meniscus. Arthroscopic diagnosis--partial excision. A case report

A case of a rare, large discoid medial meniscus with a bucket-handle tear is described. The radiogram was normal and the clinical impression was torn medial meniscus. A diagnostic arthroscopy revealed an unusually large medial discoid meniscus with a bucket-handle tear. Open partial excision was performed following the arthroscopy.     

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。     

Bilateral complete discoid medial meniscus: a case report

Discoid medial meniscus is very rare, and bilateral discoid medial meniscus is extremely rare. We report a case of bilateral discoid medial meniscus. The patient had symptoms in the right knee but was asymptomatic in the left knee. We performed magnetic resonance imaging for both knees. The patient was treated by saucerization and by all inside repair of the anterior horn tear in the right knee. We performed second-look arthroscopy after 18 months.     

A novel suture technique using the FasT-Fix combined with Ultrabraid for pullout repair of the medial meniscus posterior root tear

Medial meniscus posterior root has an important role in the maintenance of knee articular cartilage. Although pullout repair of the medial meniscus posterior root tear has become a gold standard, it has several difficulties for suturing. We have developed a modified Mason–Allen suture technique using the FasT-Fix all-inside suture device combined with Ultrabraid. The present suture technique allows a strong grasping of the medial meniscus posterior horn for arthroscopic pullout repair.