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Scott A. Rodeo MD andRussell F. Warren MD 《Operative Techniques in Sports Medicine》1994,2(3):217-222
Clinical and experimental studies have demonstrated the importance of the meniscus in load transmission, stability, shock absorption, and articular cartilage nutrition in the knee joint. As a result, clinicians have emphasized preservation of the injured meniscus when possible. Meniscal healing is dependent on a blood supply or factors derived from serum. An exogenous fibrin clot placed in a stable lesion in an avascular portion of the meniscus can support a reparative response by providing such serum factors. In this review, the authors describe the basic science aspects of meniscal repair and the indications, technique, and results of meniscal repair using an exogenous fibrin clot. Directions for future research on meniscal repair and replacement based on increasing understanding of meniscal biology are briefly discussed. 相似文献
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Kenneth E. Dehaven MD Robert D. Bronstein MD 《Operative Techniques in Sports Medicine》1994,2(3):172-176
Open repair of meniscal tears within 1 to 2 mm of the meniscosynovial junction can provide an anatomical repair with vertically oriented sutures. The rationale and indications for open meniscus repair are presented along with the techniques for both lateral and medial meniscus repair and aftercare principles. 相似文献
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目的探讨关节镜下半月板缝合修补术在半月板桶柄样撕裂(bucket-handle tear,BHT)中的治疗价值。方法 2014年4月—2017年4月陕西省第四人民医院收治90例BHT患者,根据随机数字表法将其分成关节镜下修补组、部分切除组各45例。部分切除组行半月板部分切除术,男性26例,女性19例;年龄18~56岁,平均32. 91岁;左膝25例,右膝20例;致伤原因:道路交通伤19例、运动伤21例、其他5例。关节镜下修补组行关节镜下半月板缝合修补术,男性27例,女性18例;年龄18~59岁,平均34. 29岁;左膝28例,右膝17例;致伤原因:道路交通伤17例、运动伤21例、其他7例。两组均上门随访12个月,在末次随访时评估愈合情况。利用Lysholm评分系统评估患者术前、末次随访时膝关节功能变化,并经MRI检查分析术前、术后6个月、末次随访时的膝关节活动度,观察术后并发症发生率。结果关节镜下修补组治愈率为97. 78%,较部分切除组的95. 56%差异无统计学意义(P> 0. 05)。关节镜下修补组末次随访时Lysholm评分高于部分切除组,差异有统计学意义(P <0. 05)。关节镜下修补组膝关节活动度术后6个月(133. 92±3. 65)°、末次随访时(142. 56±5. 46)°大于部分切除组(124. 63±3. 27)°、(135. 38±5. 13)°,差异有统计学意义(P <0. 05)。关节镜下修补组并发症发生率为4. 44%,较部分切除组的13. 33%差异无统计学意义(P> 0. 05)。结论关节镜下行半月板缝合修补术能促进膝关节功能恢复,改善膝关节活动度,并发症发生率低,值得临床推广。 相似文献
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Nikolaos Koukoulias Stergios Papastergiou Konstantinos Kazakos Georgios Poulios Konstantinos Parisis 《Knee surgery, sports traumatology, arthroscopy》2007,15(2):138-143
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. 相似文献
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Arthroscopic all-inside repair techniques of lateral meniscus anterior horn tear: a technical note 总被引:1,自引:0,他引:1
Choon Key Lee Jeung Tak Suh Chong Il Yoo Hyung Lae Cho 《Knee surgery, sports traumatology, arthroscopy》2007,15(11):1335-1339
Although the conventional outside-in technique is especially useful for repairing tears in the anterior portion of the meniscus,
it has a disadvantage of making an additional 1–2 cm sized skin incision and tying knots subcutaneously over the capsule.
Therefore we devised two all-inside repair techniques of lateral meniscus anterior horn tear according to the site of meniscal
tear, meniscosynovial junction or red–red zone. Because these techniques are modified methods of the outside-in meniscal repair
using a spinal needle, they are as simple as conventional outside-in technique. In addition they have advantages of vertical
mattress suture, which is an important characteristic of the all-inside repair, and no additional incision. We recommend these
techniques as an alternative method for repairing an anterior horn tear of the lateral meniscus. 相似文献
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The arthroscopic “all-inside” meniscus suturing technique offers the arthroscopist a way of placing vertically oriented sutures through peripheral posterior horn tears located posterocentral without the risks of nerve, vessel, or posterior capsular entrapment inherent in both the “outside-in” and the “inside-out” arthroscopic methods. This technique introduces new instrumentation that allows the surgeon to both place sutures and tie suture knots intra-articularly under arthroscopic control. 相似文献
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Arthroscopic all-inside repair for a tear of posterior root of the medial meniscus: a technical note 总被引:2,自引:1,他引:1
Nam-Hong Choi Kyung-Mo Son Brian N. Victoroff 《Knee surgery, sports traumatology, arthroscopy》2008,16(9):891-893
This technical note describes a new arthroscopic technique to repair a tear of posterior root of the medial meniscus. Cartilage at the insertion area of the posterior horn of the medial meniscus (PHMM) was removed using a curved curette inserted through an anteromedial portal. A metal anchor loaded with two FiberWires (Arthrex, Naples, FL) was placed at the insertion area of the PHMM through a high posteromedial portal. A PDS suture was passed the PHMM by curved suture hook through the anteromedial portal. Two limbs of the PDS were then used to pass two limbs of the FiberWire through the meniscus. The same procedure was repeated for the second FiberWire suture. The sutures were tied, achieving secure fixation of the posterior meniscal root at the anatomic insertion. 相似文献
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Jin-Ho Cho 《Knee surgery, sports traumatology, arthroscopy》2008,16(7):683-686
Several techniques have been used for the arthroscopic repair of anterior horn tears of the lateral meniscus. A commonly used method is the outside-in technique. This technique is known to be the most appropriate and safest technique for peripheral tears of the anterior horn of the lateral meniscus. But it has the disadvantage of making an additional 1-2 cm sized skin incision and tying knots subcutaneously over the capsule. Irritation may also occur. We have developed a new alternative repair method to prevent this skin incision and preserve the normal biomechanics of the lateral meniscus during motion. These techniques are modified methods of the outside-in meniscal repair using a spinal needle. They are as simple as conventional outside-in technique. In addition, they have advantages of vertical mattress suture, which is an important characteristic of the all-inside repair, and no additional incision. We recommend these methods as an alternative technique for repairing an anterior horn tear of the lateral meniscus. 相似文献
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Despite the considerable technological advances in arthroscopic surgery in the past decade, it is of concern that meniscal repair is not being done in many cases where the meniscus tear is reparable and the patient, if properly informed, would desire it.There is accumulating evidence that the long-term benefits of meniscal repair significantly outweigh those of partial meniscectomy. But success must be tempered by looking at longer follow-up assessments than we are accustomed to doing.DeHaven found that the average time between surgery and failure was 4 years, in a study averaging 11 years of follow-up. Meniscal repairs in isolated tears of the meniscus are significantly less successful than repairs of meniscal tears associated with anterior cruciate ligament (ACL) reconstruction. There is evidence that isolated meniscal tears in ACL-stable knees occur in menisci that are significantly more degenerated compared with menisci having tears associated with ACL disruption. Improved techniques of meniscal repair include the abrasion of both sides of the tear site, the use of increased numbers of vertically oriented nonabsorbable sutures, the insertion of a fibrin clot into the tear site, and the development of completely inside-the-knee suturing techniques. In the future, meniscal repair will become simpler and faster to perform. As a result, more meniscal repairs will be attempted. Over the next decade, we will see increasing research in the role of meniscal allografts and collagen (or other material) substitutes for the meniscus in patients with segmental defects or complete loss of the meniscus. 相似文献
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Jack Andrish MD 《Operative Techniques in Sports Medicine》1998,6(4):186-196
Meniscus injuries of the knee in skeletally immature athletes are uncommon. Although the epidemiology of theseinjuries is inadequately documented in the literature, it is clear that meniscus injuries in children are often found with congenitally abnormal menisci. In the adolescent, these injuries are often found with associated ligamentous injury. Longitudinal and peripheral injury patterns prevail. Because of these injury patterns and the enhanced healing potential of youth, meniscus repair is preferred more often in youths than in adults. The Snapping Knee syndrome is typically associated with discoid menisci in children and youth. Watanabe described a classification of discoid menisci that includes the unstable Wrisberg ligament type as well as the partial and complete types. No treatment is required for the asymptomatic discoid meniscus, but the symptomatically unstable meniscus may be repaired and the symptomatic stable partial or complete discoid meniscus saucerized or, if torn, replaced if possible. Although meniscus replacement is theoretically an attractive alternative choice of treatment over excision or debridement, not enough is known about clinical outcomes and safety to justify their use in the skeletally immature patient. 相似文献
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Mark D. Miller MD Joseph R. Ritchie MD Christopher D. Harner MD 《Operative Techniques in Sports Medicine》1994,2(3):164-171
Several basic sciences studies have laid the foundation for successful meniscal repair. There are currently four techniques for meniscal repair that are popular: open, “inside-out,” “outside-in,” and “all-inside.” Because of near universal development of late osteoarthritis after total and even partial meniscectomy, there has been increased emphasis on preserving the meniscus whenever possible, and greater interest in expanding the indications for meniscal repair. This article suggests several indications for repair and summarizes the key components of each technique. The use of “enhancing” techniques, such as fibrin clot, fibrin glue, and various grafting techniques, may expand future indications for meniscal repair. 相似文献
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Nikolaos Koukoulias Stergios Papastergiou Konstantinos Kazakos Georgios Poulios Konstantinos Parisis 《Knee surgery, sports traumatology, arthroscopy》2007,15(2):133-137
The short-term clinical results of meniscus repair with the meniscus arrow were promising. Unfavorable outcomes were reported
in two studies, with longer follow-up, raising concerns about the efficacy of this device. We retrospectively reviewed 62
patients (mean age 23.7 years; range 14–37 years) that underwent all-inside meniscus repair, using the meniscus arrow. Seventeen
patients had an isolated meniscus tear (ACL intact group) and 45 patients concomitant ACL rupture that was reconstructed at
the same time with the meniscus repair (ACL reconstructed group). All patients followed a non-aggressive rehabilitation protocol.
Follow-up was assessed by clinical examination, Lysholm and Tegner score, IKDC knee examination form and KT-2000 arthrometry
for the anteroposterior laxity of the reconstructed knees. At an average follow-up of 73 months (range 49–96 months) there
were three failures (4.8%), one from the ACL intact group and two from the ACL reconstructed group. One patient developed
arthrofibrosis (ACL reconstructed group) that resolved conservatively. Soft tissue irritation at the repair site was noted
in three patients. In two patients the symptoms were transient. In the third patient the arrow tip was cut off under local
anaesthesia due to saphenous infrapatellar branch irritation and the symptoms resolved (inappropriate arrow size). KT-2000
arthrometry showed that sagittal knee laxity was less than 3 mm in all reconstructed knees. The mean Tegner activity score
decreased from 6.7 (pretrauma) to 6.2 (postoperatively). The average Lysholm score was 96, with normal or nearly normal function
of all success knees, according to the IKDC knee examination form. Our results show a high clinical success rate of meniscus
repair with the meniscus arrow. We found this device both safe and effective. 相似文献
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Joan C. Monllau Gemma González Lluís Puig Enric Cáceres 《Knee surgery, sports traumatology, arthroscopy》2006,14(2):112-113
Only a few cases of the nearly unknown hypoplastic meniscus abnormality have been described. A case report of an incidental finding in a young female with a bilateral hypoplastic medial menisci is presented and, as far as we know, is the first report of bilateral hypoplasia of the medial meniscus in the literature. 相似文献
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The arrow versus horizontal suture in arthroscopic meniscus repair
A prospective randomized study with arthroscopic evaluation 总被引:4,自引:6,他引:4
P. Albrecht-Olsen G. Kristensen P. Burgaard U. Joergensen C. Toerholm 《Knee surgery, sports traumatology, arthroscopy》1999,7(5):268-273
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 相似文献