Effects of arthroscopic meniscectomy on the long-term prognosis for the discoid lateral meniscus

This study compared the long-term clinical and radiological outcomes, according to the extent of arthroscopic meniscectomy, of complete and incomplete types of the discoid lateral meniscus. A total of 125 discoid menisci (74 complete and 51 incomplete types) without significant cartilage erosion at the time of surgery were included. The extent of meniscectomy was decided along with tear patterns and the stability of the discoid meniscus. Both clinical and radiological results were evaluated after total or partial meniscectomy. In the complete type of discoid meniscus with less than 5 years of follow-up, the total meniscectomy group showed better clinical results than the partial meniscectomy group. However, with over 5 years of follow-up, there were no differences between the two groups. In the radiological results, there was no significant difference between the two groups during the first 5 years after operation. However, with more than 5 years of follow-up, the partial meniscectomy group showed better results than the total meniscectomy group. In the incomplete-type discoid meniscus, clinical results were better in the partial meniscectomy group regardless of the follow-up periods. In the radiological results, the partial meniscectomy group showed better results for only more than 5 years of follow-up. The long-term prognosis after arthroscopic meniscectomy for the torn discoid lateral meniscus was related to the volume of the meniscus removed.     

Cost effectiveness of meniscal allograft for torn discoid lateral meniscus in young women

Objective: A discoid meniscus is more prone to tears than a normal meniscus. Patients with a torn discoid lateral meniscus are at increased risk for early onset osteoarthritis requiring total knee arthroplasty (TKA). Optimal management for this condition is controversial given the up-front cost difference between the two treatment options: the more expensive meniscal allograft transplantation compared with standard partial meniscectomy. We hypothesize that meniscal allograft transplantation following excision of a torn discoid lateral meniscus is more cost-effective compared with partial meniscectomy alone because allografts will extend the time to TKA.

Methods: A decision analytic Markov model was created to compare the cost effectiveness of two treatments for symptomatic, torn discoid lateral meniscus: meniscal allograft and partial meniscectomy. Probability estimates and event rates were derived from the scientific literature, and costs and benefits were discounted by 3%. One-way sensitivity analyses were performed to test model robustness.

Results: Over 25 years, the partial meniscectomy strategy cost $10,430, whereas meniscal allograft cost on average $4040 more, at $14,470. Partial meniscectomy postponed TKA an average of 12.5 years, compared with 17.30 years for meniscal allograft, an increase of 4.8 years. Allograft cost $842 per-year-gained in time to TKA.

Conclusion: Meniscal allografts have been shown to reduce pain and improve function in patients with discoid lateral meniscus tears. Though more costly, meniscal allografts may be more effective than partial meniscectomy in delaying TKA in this model. Additional future long term clinical studies will provide more insight into optimal surgical options.     

An arthroscopic analysis of lateral meniscal variants and a comparison with MRI findings

We reviewed 164 consecutive cases (158 patients) of arthroscopic examinations for lateral meniscal variants during the last 10 years. We classified lateral meniscal variants into four types by arthroscopic appearance, into six tear patterns by modifying OConnors classification, and compared magnetic resonance images (MRI) with arthroscopic findings. Regarding the four types, 131 cases were complete, 25 cases were incomplete, 4 cases were Wrisberg, and 4 cases were ring-shaped meniscus. The six tear patterns were as follows: 33 simple horizontal, 21 combined horizontal, 37 longitudinal, 27 central, 14 complex, and 12 radial tear. Among the 31 knees with a central tear or ring-shaped meniscus, we reviewed 25 MR images. Fifteen (60%) MRI findings were interpreted to represent a bucket-handle (displaced) tear of the normal C-shaped meniscus; 7(28%) MRI findings, a discoid meniscal tear; and the remaining 3(12%) MRI findings, a simple meniscal tear. Moreover, all ring-shaped menisci were interpreted as a displaced lateral meniscal tear on the MRI findings. Twelve patients (13 knees, 7.9%) had osteochondritis dissecans: Nine patients (10 knees) of them had a central tear, two patients (2 knees) of them had a simple horizontal tear of the discoid meniscus, and one patient (1 knee) had a ring-shaped meniscus. Twenty three patients (92.6%) with a central tear of the discoid meniscus did not have any traumatic events. For the differential diagnosis of a central tear or a ring-shaped meniscus from a bucket-handle tear of the normal C-shaped meniscus, we should take a careful history, in particular any traumatic events, we should also consider the possibility of misinterpreting the MR images though these images can provide additional information about associated abnormalities and probe carefully in the arthroscopic operations.     

关节镜下半月板部分切除术治疗膝关节半月板损伤的临床研究

目的探讨膝关节半月板损伤经关节镜下半月板部分切除术的治疗效果。方法回顾性分析新乡医学院第一附属医院骨科2013年8月—2016年8月收治的103例膝关节半月板损伤患者的临床资料,根据治疗方案将患者分为半月板成形术组(32例):男性19例,女性13例;致伤原因:道路交通伤19例,摔伤8例,高处坠落伤5例;非手术组(33例):男性20例,女性13例;致伤原因:道路交通伤18例,摔伤10例,高处坠落伤5例;半月板部分切除术组(38例):男性22例,女性16例;致伤原因:道路交通伤23例,摔伤9例,高处坠落伤6例。比较3组治疗前、治疗6个月、2年后的膝关节活动度、疼痛程度以及膝关节功能。结果半月板部分切除术组、半月板成形术组优良率均高于非手术组,且半月板部分切除术组高于半月板成形术组(P<0.05)。3组治疗6个月、2年后膝关节功能评分、膝关节活动度呈先升高后降低趋势(P<0.05);半月板成形术组、半月板部分切除术组治疗6个月、2年后膝关节功能评分、膝关节活动度均高于非手术组,且半月板部分切除术组高于半月板成形术组(P<0.05)。3组患者治疗6个月、2年后VAS评分呈先降低后升高趋势(P<0.05);半月板成形术组、半月板部分切除术组治疗6个月、2年后VAS评分均低于非手术组,且半月板部分切除术组低于半月板成形术组(P<0.05)。结论膝关节半月板损伤经关节镜下半月板部分切除术治疗,疗效确切,可有效改善患者膝关节活动度、膝关节功能,减轻机体疼痛感,具有临床应用价值。     

Clinical,radiologic and arthroscopic assessment and treatment of bilateral discoid lateral meniscus

The purpose of the study is to evaluate clinical, radiologic and arthroscopic features of bilateral discoid lateral meniscus and to assess the outcome of arthroscopic meniscectomy. Among the 177 arthroscopies performed for discoid lateral meniscus between January 1993 and January 2004, 12 were bilateral. The clinical and radiologic evaluation was done from the records. The type of discoid meniscus, the type of tear was assessed arthroscopically. All patients underwent arthroscopic meniscectomy. Patients were followed up for a minimum period of 2 years. All patients had pain as presenting symptom. Eight patients presented with bilateral knee pain and four patients developed pain in the opposite knee after the affected knee was treated. The classically described thud was present in 11 knees. The widening of the joint space was found in 13 knee radiographs; 14 knees had complete type, nine had incomplete type and one had ring type of discoid lateral meniscus on arthroscopic evaluation; 20 knees involving 10 complete types, all incomplete types and ring type of discoid lateral meniscus showed obvious meniscal tears. The remaining four meniscus showed softening of a portion of the meniscus. Underlying intra-substance tear was visualized arthroscopically in the softened areas on saucerisation. All but one discoid menisci underwent arthroscopic partial central meniscectomy. When followed up for an average period of 32.6 months 19 knees showed excellent results and 5 knees good results. Possibility of bilaterality should be suspected in discoid lateral meniscus. Softening of meniscus denotes underlying intra-substance tear. This finding has not been described in the literature so far. Arthroscopic partial meniscectomy gives good results in symptomatic bilateral discoid meniscus. This to our knowledge is the largest series of bilateral discoid lateral menisci.     

盘状半月板周缘稳定性的MRI评估

盘状半月板是半月板的异常发育引起的半月板畸形,容易引起周缘不稳。MRI检查作为一种无创的影像学检查方法,敏感性及特异性较高,可以发现盘状半月板周缘不稳的征象,本文重点综述了盘状半月板周缘稳定性的MRI征象及这些征象是如何引发的周缘不稳。     

MRI对军事训练致盘状半月板损伤的临床应用价值

目的:探讨MRI对军事训练致膝关节盘状半月板损伤的临床应用价值。方法:回顾性分析36例武警部队军人盘状半月板资料,其中33例经关节镜证实盘状半月板撕裂,33例撕裂病例均有明确的军事训练致伤史,观察盘状半月板形态、大小及信号改变,判断盘状半月板及其损伤分型。结果:36例盘状半月板,均发生在外侧。36例中,板型21例,楔型9例,肥角型6例。33例盘状半月板发生撕裂,以关节镜为诊断标准,MRI诊断膝关节盘状半月板准确率为100%,MRI诊断盘状半月板水平撕裂、斜行撕裂、纵行撕裂、放射状撕裂、桶柄状撕裂及复杂撕裂的准确性分别为91.7%、94.4%、100%、97.2%、91.7%、94.4%。结论:MRI对军事训练致盘状半月板撕裂能清晰显示、准确分型,对临床治疗方案的制定有重要的指导作用,具有较高的临床应用价值。     

Atypically thick and high location of the Wrisberg ligament in patients with a complete lateral discoid meniscus

The purpose of this study was to document the relationship between a discoid lateral meniscus and a thickened Wrisberg ligament with a higher location on the medial femoral condyle.Between July 2002 and February 2006, 100 consecutive patients who had a complete lateral discoid meniscus and another 100 patients without a discoid lateral meniscus (control group) were included. Two radiologists retrospectively reviewed all of the magnetic resonance images, paying particular attention to the presence and thickness of the Wrisberg ligament and the location of the attachment of the Wrisberg ligament to the medial femoral condyle (types I, II, or III). We assumed that type I Wrisberg ligaments had a higher location.All 141 patients had a Wrisberg ligament (71%). There were 73 patients (73%) in the discoid group and 68 patients (68%) in the non-discoid group. The mean thickness of the Wrisberg ligament in the patients in the discoid and non-discoid groups was 2.1 mm (range, 0.4-4.7 mm; median, 2.1 mm) and 1.6 mm (range, 0.4-4.5 mm; median, 1.3 mm), respectively. The Wrisberg ligaments of the discoid group were thicker than the non-discoid group (p = 0.0002). The Wrisberg ligament was attached to the upper part of the medial femoral condyle in the discoid group more often than in the non-discoid group (p < 0.0001).     

探讨关节镜治疗膝关节盘状半月板损伤的临床疗效及术后疼痛的影响因素

目的研究并探讨关节镜治疗膝关节盘状半月板损伤的临床疗效,并对导致其术后疼痛的影响因素进行分析。方法回顾性分析2013年1月—2016年8月宁夏人民医院骨科收治且随访成功的200例膝关节盘状半月板损伤患者的临床资料。男性86例,女性114例,年龄12~76岁,平均45.24岁。左侧膝关节半月板损伤103例、右侧97例,损伤类型均为圆盘状;损伤分度依据MRI信号进行划分,Ⅰ度32例、Ⅱ度67例、Ⅲ度101例。所有患者均接受关节镜手术治疗,对其治疗效果进行观察,统计术后出现疼痛的病例,并分为疼痛组、无痛组,比较两组患者的Lysholm膝关节功能评分,并对两组患者的各项临床资料进行比较,对导致患者术后疼痛的影响因素进行单因素、多因素Logistics回归分析。结果经关节镜手术治疗后,200例患者的疗效评定结果为优119例、良75例、可4例、差2例,优良率为97.0%。术后56例患者出现膝关节疼痛,疼痛发生率为28.0%。疼痛组患者手术后的Lysholm评分(67.62±12.21)分明显低于无痛组(83.45±13.57)分(P0.05)。经单因素分析、多因素Logistics回归分析后得出,导致术后疼痛的影响因素主要为患者年龄大、关节软骨损伤、术后过早负重、术后未接受冷敷。结论关节镜治疗膝关节盘状半月板损伤的临床疗效显著,但术后患者容易出现膝关节疼痛,临床上应针对术后疼痛发生的相关因素进行相应的处理。     

膝关节外侧盘状半月板损伤与软骨损伤的相关性研究

目的探究单膝外侧盘状半月板(discoid lateral meniscus,DLM)损伤与膝关节软骨损伤的关系并分析合并单膝DLM的膝关节软骨损伤的危险因素。方法 2011年1月~2014年1月,根据纳入与排除标准笔者共收治于MRI下诊断为单膝DLM患者166例,女性103例,男性63例;年龄7~48岁,平均38岁。记录患者盘状半月板变性撕裂情况,并根据半月板损伤情况分为完整组(10例)、变性组(122例)和撕裂组(34例),利用全器官MRI评分(whole-organ magnetic resonance imaging score,WORMS)法对膝关节软骨损伤情况进行评分,记录患者性别、年龄、BMI指数,通过单因素方差分析比较三组间一般情况以及膝关节软骨损伤评分的差异。对三组患者进行多因素Logistic回归分析,探讨其膝关节软骨损伤的危险因素。结果完整组、变性组、撕裂组三组平均年龄分别为(39.8±19.5)岁、(37.9±15.5)岁、(36.3±15.6)岁,差异均无统计学意义(P0.05);BMI指数分别为23.3、23.7、24.8,差异均无统计学意义(P0.05)。膝关节软骨总体评分在三组间不全相等(P0.01),根据最小显著差异法(least significant difference,LSD)进行两两比较,撕裂组总评分高于变性组(P0.01),变性组高于完整组(P=0.005)。所有患者经多因素Logistic回归分析,性别(P=0.020;OR 1.097[0.132~3.841])、BMI指数(P0.01;OR 16.048[6.042~42.628])及DLM损伤(P=0.011;OR 6.137[1.516~24.800])均是软骨损伤的独立危险因素。结论在伴有单膝DLM的患者中,女性、BMI24kg/m2及DLM损伤为膝关节软骨损伤的独立危险因素,且DLM损伤程度越高,膝关节软骨损伤程度也越高。     

关节镜下盘状半月板损伤治疗效果影响因素分析

目的探讨关节镜下盘状半月板损伤疗效的影响因素。方法将我院2000年12月～2011年12月198例膝关节（212膝）盘状半月板损伤的关节镜手术,通过12个月以上的随访,观察患者年龄、症状持续时间、软骨损伤、损伤类型、手术方式对盘状半月板疗效的影响。术后采用Ikeuehi评价标准对膝关节功能进行评定。结果依据Ikeuehi评分标准：优74膝,良67膝,中71膝。患者年龄〈20岁,持续症状〈1年,无软骨损伤程度,半月板成型术均有利于盘状半月板损伤治疗,而损伤类型和疗效无关。结论患者年龄、症状持续时间、软骨损伤程度、手术方式对盘状半月板的治疗效果影响较大。     

关节镜下半月板切除术与成形缝合术治疗盘状半月板损伤的临床对比研究

将收治的67例盘状半月板损伤患者分为两组,成形组32例采用关节镜下成形缝合术,切除组35例采用关节镜下全切除术,对比两组手术前后Lysholm评分、活动度、国际膝关节评分委员会(IKDC)评分。认为关节镜下半月板切除术与成形缝合术均能改善患者临床症状及膝关节功能,成形缝合术疗效优于全切除术。     

The arrow versus horizontal suture in arthroscopic meniscus repair A prospective randomized study with arthroscopic evaluation

In a prospectively randomized study including 68 patients, the results of inside-out horizontal meniscus suturing were compared to meniscus repair using the meniscus arrow. 96% of the patients underwent re-arthroscopy after 3–4 months. Only lesions in the red/red or red/white areas were included. Patients were treated with a hinged brace for 9 weeks. 30 patients had an isolated bucket-handle lesion. In 19 cases the repair was done in conjunction with an ACL reconstruction and in 19 cases the repair was performed in an ACL-insufficient knee. The two groups were comparable. Operating time in the arrow group was one half that of the suture group. Of 65 re-arthroscopies, 91% of the patients had healed or partially healed in the arrow group compared to 75% in the suture group (P = 0.11). In only 50% of the non-healed cases was this clinically suspected prior to control arthroscopy. The difference between healing in ACL-reconstructed and ACL-insufficient knees was not significant. Two patients in the suture group had a deep infection. There were no serious neurovascular injuries. Five patients in the suture group and two patients in the arrow group had symptoms in the saphenous nerve area. All patients had some synovial irritation at control arthroscopy but no severe reactions to suture or arrows were seen. Short-term results with meniscus arrows, based on healing and evaluated by second-look arthroscopy, seem promising. Received: 20 May 1998 Accepted: 15 April 1999     

Wrisberg variant of the discoid lateral meniscus with flipped meniscal fragments simulating bucket-handle tear: MRI and arthroscopic correlation

An MRI diagnosis of the Wrisberg variant discoid lateral meniscus should be considered in patients presenting with an anteriorly flipped posterior horn fragment without a definable peripheral rim. We present four cases discovered on arthroscopy that were thought to resemble bucket-handle tears on preoperative MRI. Posterior hypermobility poses a surgical challenge as excessive debridement without careful attention to underlying meniscal morphology may lead to further instability. Although this diagnosis can be difficult to make on MRI, alerting the orthopedic surgeon preoperatively may influence repair technique and meniscus conservation.     

Mid-term clinical results of medial meniscus repair with the meniscus arrow in the unstable knee

The medial meniscus is a secondary stabilizer to anterior tibial translation and provides significant stability, especially in an ACL-deficient knee. The purpose of this study is to evaluate the clinical outcome of medial meniscus repair in the unstable knee. Between 1997 and 2002, 11 patients, with a mean age of 25.8 years (range 15–39 years), underwent all-inside medial meniscus repair, using the Meniscus Arrow, for unstable medial meniscus tear in ACL-deficient knees. For various reasons none of these patients underwent ACL reconstruction. The average follow-up was 73 months (range 52–91 months). There were three failures (27.3%) defined as the need for reoperation and partial meniscectomy. The mean Tegner activity score decreased from 6.75 (pretrauma) to 4.5 (postoperatively). The average Lysholm and subjective IKDC scores were 83 and 77.4, respectively. Two patients were graded as B (nearly normal) and six as C (abnormal), according to the IKDC knee evaluation form. KT-2000 arthrometry demonstrated that sagittal knee laxity was more than 5 mm in all knees (side to side difference). MRI demonstrated grade three signal alterations at the repair site of meniscus in three patients and signs of cartilage damage in two patients. All patients were asymptomatic during daily activities but seven out of eight reported pain or effusion after sports. Medial meniscus repair in the ACL-deficient knee is not contraindicated. The need of reducing the level of physical activity is essential.     

Effects of posterior-inferior capsular plications in range of motion in arthroscopic anterior bankart repair: a prospective randomized clinical study

The effects of posterior plications associated with anterior shoulder instability surgery are still unclear both on shoulder range of motion (ROM) and on recurrence rate. The objective of this randomized study is to evaluate the influence of posterior-inferior plications, performed in association with repair of anterior Bankart lesion, on gleno-humeral (GH) range of motion. In a 24-month period, 40 patients were prospectively enrolled in this study. The criteria for inclusion were age between 17 and 40 years, traumatic unidirectional instability, no previous shoulder surgery, no more than three episodes of dislocation, no relevant glenoid bone deficiency, no clinical evidence of pathological anterior inferior laxity (measured with external rotation with the arm at the side inferior to 90° and Gagey sign negative) and arthroscopic finding of isolated anterior Bankart lesion. A total of 20 patients (group A) were randomized to treat Bankart lesion using three bioadsorbable anchors loaded with a #2 braided polyester suture. In 20 randomized patients (group B) two posterior-inferior capsular plications performed with a #1 polidioxanone suture without any capsular shift were added to the same anterior capsulorraphy performed in group A. Postoperative rehabilitation protocol was the same for all 40 patients. Patients were examined preoperatively and at a 2-year follow-up by a single independent expert physician unaware of the surgical procedure. GH ROM, Constant, UCLA and ASES rating scores as well as recurrence of instability were recorded. At follow-up, forward flexion (FF) decreased by a mean value of 14.5° (median −10°; range −5° to −35°; P < 0.001) in group B and increased by a mean value of 3.5° (median 0°; range −25° to 40°; P < 0.312) in group A; external rotation with arm adducted (ER1) increased by a mean value of 1.8° (median 0°; range −15°to 30°; P < 0.924) in group B, and increased by a mean value of 2.6° (median 2.5°; range −38° to 40°; P < 0.610) in group A; external rotation with arm abducted at 90° (ER2) decreased by a mean value of 2.9° (median 0°; range: −20° to 10°; P < 0.161) in group B and increased by a mean value of 0.7° (median 0°; range −30° to 25°; P < 0.837) in group A; the IR2 decreased by a mean value of 2.4° (median −3.5°; range −15° to 10°; P < 0.167) in group B and increased by a mean value of 2.2° (median 0°; range −20° to 30°; P < 0.456) in group A. The UCLA mean score gains by 43.1% (median 40; P < 0.001) relatively, and of 45.2% relatively (median 40; P < 0.001), respectively, in group B and A, ASES mean score relatively gains by 21.7% (median 21.2%; P < 0.001) in group B, and of 19.2% (median 18.9%; P < 0.001) in group A, and Constant mean score improves by 20.2% (median 16.5; P < 0.001) in group B, and 10.2% (median 8.4%; P < 0.001) in group A. Thus, the only statistical significant differences were the reduction of forward flexion in group B and the improvements of the scores in both groups. No recurrence of instability was found in the plicated group, while in the non-plicated group we had one traumatic recurrence. In conclusion, arthroscopic posterior-inferior plications associated with a Bankart lesion repair in a selected group of patients seem to reduce only FF, without any effect on rotation. A longer follow-up and a larger number of patients are needed to give definitive conclusions on the benefit to the recurrence rate.