膝关节半月板撕裂的磁共振表现

目的进一步认识膝关节半月板撕裂的磁共振成像(MRI)表现。方法回顾分析50例膝关节半月板撕裂的MRI资料,所有病例均经关节镜手术证实。采用永磁型MRI机,场强0.2T。结果50例半月板撕裂中,按照部位分类,半月板撕裂位于内侧半月板前角2例,内侧后角37例,外侧半月板前角5例,外侧后角3例,同时累及半月板前角、体部和后角者内侧2例,外侧1例。按照半月板撕裂的形式分为:水平撕裂8例;垂直撕裂4例;斜形撕裂26例;纵形撕裂3例;放射状撕裂4例;桶柄状撕裂2例;复杂撕裂3例。结论MRI能够清楚显示膝关节半月板撕裂的部位和形式,为临床治疗提供可靠的依据,是目前诊断半月板撕裂的最好的影像学检查方法。     

内侧半月板后角“隐匿性”层裂14例报告

目的探讨内侧半月板后角"隐匿性"水平撕裂伤的临床特点及关节镜下半月板部分切除术的临床疗效。方法 2011年5月~2013年5月对14例内侧半月板后角"隐匿性"层裂采取膝关节前内、外侧入路关节镜探查,咬除半月板后角内缘后显露层裂,术中探查半月板后角底层不稳,切除底层后行半月板后角成形术。结果术中探查均为内侧半月板后角"隐匿性"层裂,6例半月板边缘及上下关节面均完整,8例水平撕裂延伸至胫骨关节面。平均手术时间32 min(26~40min),平均住院时间6 d(3~8 d)。术后切口均一期愈合,未发生膝关节感染、僵硬等并发症。14例随访2~3年,术后症状缓解,术前Lysholm评分(71.1±6.6)分,术后(92.0±3.4)分,术前后差异有统计学意义(t=10.530,P=0.000)。结论内侧半月板后角"隐匿性"层裂主要为退变性破裂,多合并软骨退变损伤,临床诊断较困难,仔细体格检查及MRI对诊断具有指导意义,关节镜下部分切除成形术可改善膝关节功能。     

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。     

关节镜下半月板撕裂部分切除术临床观察

目的探讨关节镜下半月板撕裂半月板部分切除术临床观察。方法选择膝关节半月板撕裂患者33例,其中男21例,女12例;年龄16~63岁,平均39.6岁。膝关节检查Mcmurray及Steininannn实验均有阳性发现,膝关节MRI检查提示半月板损伤。关节镜下切除部分半月板组织。结果本组33例患者术后均接受随访,随访时间3个月~2年,平均8个月。7例已出现创伤性关节炎的患者症状减轻,行走无绞锁、弹响等症状,26例患者症状消失,无一例出现血管神经损伤,无血栓及感染等。结论膝关节镜下半月板撕裂半月板部分切除术能够缓解疼痛,改善功能,提高生活质量。     

MRI放射状扫描成像诊断半月板撕裂的价值

【摘要】 目的 探讨MRI放射状扫描序列对膝关节半月板撕裂的诊断价值及对临床治疗的指导意义。方法 回顾性分析58 例疑有膝关节半月板撕裂患者的MRI常规扫描及放射状扫描图像,两者相互比较,并将常规扫描诊断结果、常规和放射状扫描两者相互结合后的结果分别与关节镜结果对比分析。结果 常规扫描序列和放射状扫描序列对半月板撕裂的诊断结果无统计学差异;放射状扫描和常规扫描相结合能增加诊断的敏感性和特异性。MRI常规检查(常规扫描结合放射状扫描)对于内侧半月板前角、体部及后角撕裂的诊断灵敏度分别为62.50%(62.50%),80.90%(95.23%),72.72%(78.78%);特异度为98.00%(94.00%),89.19%(78.37%),92.30%(92.30%)。MRI常规检查(常规扫描结合放射状扫描)对于外侧半月板前角、体部及后角撕裂的诊断灵敏度分别为64.28%(78.57%),76.47%(88.00%),82.35%(94.11%);特异度为97.72%(96.45%),92.68%(85.36%),97.56%(97.56%)。结论 MRI 常规扫描结合放射状扫描对半月板边缘部、近根部的损伤以及半月板损伤的细节显示优于常规扫描,二者结合可减少假阴性率和假阳性率,放射状扫描序列可作为重要的辅助诊断方法。     

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。     

关节镜下后角切除治疗膝关节内侧半月板后角损伤

目的 探讨关节镜下后角切除治疗内侧半月板后角损伤的近期疗效。方法 2003年1月-2005年6月，108例（114膝）膝关节稳定的内侧半月板后角损伤患者在关节镜下行半月板后角全部切除或部分切除术，其中男42例（44膝），女66例（70膝）；左侧69膝，右侧33膝，双侧6例（12膝）；平均年龄48．3岁（18-73岁）。通过Lysholm膝关节评分系统评价治疗效果，并与术前进行比较。结果 术后随访10～40个月（平均26．4个月），Lysholm评分从术前平均（58．7±17．6）分提高至随访时平均（93．8±8．5）分，差异有统计学意义（P〈0．01），术后膝关节功能的优良率达到94．7％。结论 关节镜下治疗内侧半月板后角损伤是一种安全有效的方法。     

关节镜下诊治膝内侧盘状半月板4例

目的 :探讨关节镜下诊治的4例膝内侧盘状半月板的临床特点。方法 :自2012年4月至2015年5月,采用关节镜诊治膝关节内侧盘状半月板4例(4膝),其中男1例,女3例;年龄7~56岁,平均26岁。4例患者均在关节镜下行半月板成形术,观察术后症状体征并采用Lysholm膝关节评分进行疗效评价。结果:4例患者均获得随访,时间6~20个月,平均12个月。末次随访时患膝Lysholm评分为83.5±10.0,其中优2膝,良1膝,中1膝。结论:膝内侧盘状半月板早期临床症状不典型,容易漏诊,常因半月板撕裂产生明显症状而就诊,确诊后宜尽早手术,半月板成形术疗效良好。     

MRI在ACL合并伤中对半月板损伤诊断评价

目的通过关节镜检查,评价术前MRI检查在前交叉韧带(ACL)合并伤中半月板损伤的诊断符合率。方法选取2014年1月至2020年6月因外伤致ACL损伤,术前阅读MRI检查,评估ACL损伤患者的半月板损伤情况,并术中关节镜检查确诊半月板损伤部位及损伤类型,进一步评价MRI诊断符合率。结果 MRI检查对内侧半月板损伤的诊断率明显高于外侧半月板损伤的诊断符合率,但差异无明显统计学差异(P0.05)。MRI对内侧半月板前角和外侧半月后角的诊断符合率较低。结论在ACL损伤合并半月板损伤中,MRI对内侧半月板前角和外侧半月后角的诊断符合率较低,因此术前应更加仔细阅读MRI,以免漏诊。     

内侧半月板Ramp损伤的研究进展

前交叉韧带损伤常合并内侧半月板Ramp损伤,陈旧性前交叉韧带损伤更易合并内侧半月板Ramp损伤。MRI与膝关节镜检查是确诊内侧半月板Ramp损伤的主要方法。内侧半月板Ramp损伤以手术治疗为主,包括关节镜下内侧半月板后角部分切除、单纯撕裂部位的创面新鲜化技术或全内缝合术式。Ramp损伤,近期疗效显著,远期疗效有待进一步观察。本文对国内外近年有关内侧半月板Ramp损伤的相关文献进行综述。     

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。     

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.     

Arthroscopic management of degenerative meniscus tears in patients with degenerative arthritis

Frequently, meniscal pathology accompanies degenerative changes affecting the articular surface of the knee. The attritional changes in the meniscus lead to fragmentation of the meniscus and a variety of tears, usually of the posterior horn of the medial meniscus. A prospective study of the results of arthroscopic partial meniscectomy in the presence of at least Outerbridge Grade III chondromalacia of the accompanying joint surface was performed between 1980 and 1984. Eighty-seven knees in 84 patients were studied. The mean age was 62 (29-84) years. The right knee was involved in 44 patients, and 47 were men. Preoperative radiographs demonstrated osteoarthritis in 53 patients. The medial meniscus was involved in 82, while the lateral meniscus was affected in nine knees. Four knees had involvement of both menisci. In 72 knees, the most frequent lesion was a tear of the posterior horn of the medial meniscus. The most frequent configuration of the tears was a flap in 42. The morbidity was small with the use of ambulatory aids being 10 +/- 13 (mean +/- SD) days. Subsequent surgery was performed on six knees consisting of two total knee arthroplasties, two upper-tibial osteotomies, one repeat arthroscopic meniscectomy, and one popliteal cyst excision. Two patients had poor results related to progression of their arthritis and one developed osteonecrosis. Five patients were unchanged from their preoperative status. Subchondral sclerosis or osteophytes on the preoperative radiographs correlated with 72% compared to 90% satisfactory results in the absence of these findings (p less than 0.03). Complications consisted of superficial thrombophlebitis in three, hemarthrosis in one, and superficial infection in one patient.(ABSTRACT TRUNCATED AT 250 WORDS)     

Surgical outcomes after arthroscopic partial meniscectomy

Much research has been done to determine clinical and demographic variables associated with outcomes from arthroscopic partial meniscectomy for meniscal tears. We undertook a review of the literature to determine trends regarding outcomes from this procedure. Independent variables were analyzed for associations with outcome, and outcome measures and methods of statistical analysis were reviewed. Results of these studies demonstrate that patient age and sex had no significant association with any clinical or radiographic outcome variables at 8.5, 12, and 15 years. Patients with flap tears had slower return to sports and more revisions than did those with bucket handle tears. Osteoarthritis progressed more after medial partial meniscectomy in patients older than age 40 years than in younger patients. No statistically significant difference in medial versus lateral meniscectomy overall was shown. The best radiographic results in patients who underwent medial meniscectomy occurred in valgus knees compared with varus knees. Increased Modified Outerbridge cartilage scores at the time of surgery correlated with poorer physical results at 12 years.     

Arthroscopic Partial Medial Meniscectomy: An Analysis of Unsatisfactory Results

Results of 150 arthroscopic partial medial meniscectomies were analyzed by computer to identify the factors that lead to an unsatisfactory (fair or poor) outcome. The average follow-up for the group was 36 months (range 24-60 months). One-hundred ten men and 40 women were involved, with an average age of 48 years. The overall results were 58% excellent-good, 28% fair, and 14% poor. Most tears involved the posterior horn (76%). Bucket handle, longitudinal, and flap tears were rated 88% excellent-good, whereas horizontal cleavage and degenerative and complex tears had only 45% excellent-good scores. The results were adversely affected by the severity of the chondromalacia, work-related injury, prior knee surgery, simultaneous lateral meniscectomy, and increased knee laxity. Because degenerative posterior horn tears had such a high percentage of unsatisfactory results, the question remains as to whether all these tears need to be removed.     

Arthroscopic partial medial meniscectomy: an analysis of unsatisfactory results

Results of 150 arthroscopic partial medial meniscectomies were analyzed by computer to identify the factors that lead to an unsatisfactory (fair or poor) outcome. The average follow-up for the group was 36 months (range 24-60 months). One-hundred ten men and 40 women were involved, with an average age of 48 years. The overall results were 58% excellent-good, 28% fair, and 14% poor. Most tears involved the posterior horn (76%). Bucket-handle, longitudinal, and flap tears were rated 88% excellent-good, whereas horizontal cleavage and degenerative and complex tears had only 45% excellent-good scores. The results were adversely affected by the severity of the chondromalacia, work-related injury, prior knee surgery, simultaneous lateral meniscectomy, and increased knee laxity. Because degenerative posterior horn tears had such a high percentage of unsatisfactory results, the question remains as to whether all these tears need to be removed.     

The posterior medial complex disruption

Seventy-five patients with 86 complex tears of the medial meniscus posterior horn (posterior medial complex disruptions) treated by arthroscopic partial meniscectomy were contacted for evaluation of their functional results. Forty-five patients returned for physical and radiographic examination 1 to 6 years after surgery. Condylar chondromalacia was significantly higher in patients waiting to undergo surgery over 6 months from the onset of their symptoms (94%) than those waiting less than 6 months (40%) (P = .0001). Patients were classified into phases based on preoperative x-rays and the operative presence of condylar chondromalacia. Satisfactory results were seen in 87% of phase 0 and phase 1 patients, 50% of phase 2 patients, and 32% of phase 3 patients. Phase classification provided significant data for prognostication of satisfactory results (P = .0001). With advancing age, presence of preoperative x-ray changes, the articular cartilage damage may compromise the results. Most patients in this study exhibited clinical improvement suggesting some benefit from the mechanical washout, if not the meniscectomy.     

Effect of partial meniscectomy at the medial posterior horn on tibiofemoral contact mechanics and meniscal hoop strains in human knees

We examined the influence of partial meniscectomy of 10 mm width on 10 human cadaveric knee joints, as it is performed during the treatment of radial tears in the posterior horn of the medial meniscus, on maximum contact pressure, contact area (CA), and meniscal hoop strain in the lateral and medial knee compartments. In case of 0° and 30° flexion angle, 20% and 50% partial meniscectomy did not influence maximum contact pressure and area. Only in case of 60° knee flexion, 50% partial resection increased medial maximum contact pressure and decreased the medial CA statistically significant. However, 100% partial resection increased maximum contact pressure and decreased CA significantly in the meniscectomized medial knee compartment in all tested knee positions. No significant differences were noted for meniscal hoop strain. From a biomechanical point of view, our in vitro study suggests that the medial joint compartment is not in danger of accelerated cartilage degeneration up to a resection limit of 20% meniscal depth and 10 mm width. Contact mechanics are likely to be more sensitive to partial meniscectomy at higher flexion angles, which has to be further investigated.     

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.     

Bilateral Discoid Medial Menisci

Summary: This article adds 2 more cases of bilateral discoid medial menisci to the previously reported 9 cases. The radiographs of the first case revealed bilateral cupping of the medial tibial plateaus and a small lytic lesion of the left distal medial femoral metaphysis. Beside the posteriorly unstable incomplete type discoid medial meniscus, the left knee had several associated arthroscopic findings: depression of the medial tibial plateau with exposed subchondral bone, anomalous insertion of the anterior horn of the discoid meniscus to the anterior cruciate ligament, a pathological medial plica, and longitudinal deep fissures in the trochlea. The second case was a complete type with peripheral horizontal cleavage tears. Following arthroscopic surgery, magnetic resonance imaging (MRI) scans of the contralateral knees were obtained in both cases to search for bilaterality. MRI revealed discoid medial menisci in the unoperated knees as well. The short-term results of arthroscopic meniscectomy may not be as satisfactory as those reported for normal menisci.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 16, No 1 (January-February), 2000: pp 96–101