前交叉韧带损伤合并内侧半月板桶柄样撕裂的临床治疗

目的:回顾性评估前交叉韧带(ACL)损伤合并内侧半月板桶柄样撕裂(BHT)的关节镜下修补疗效。方法:2002年5月~2007年2月,67例前交叉韧带损伤合并内侧半月板桶柄样撕裂手术病例。入选条件为:红-红区及红-白区损伤、具备可复位性、半月板组织无复合撕裂及明显变性,进行过二次手术探查。手术技术:前交叉韧带关节镜下重建。内侧半月板修补采用关节镜下联合修补方法:后体部至前体部区域采用标准的自内向外缝合技术,后部区域采用经两个后内侧入路的全关节内缝合技术。结果:平均随访40.6个月(12个月~70个月)。二次手术探查结果:完全愈合57例(85%),部分愈合3例(4.5%),不愈合7例(10.4%)。总体成功率(包括完全愈合与部分愈合)为89.5%。临床评估包括交锁、积液、关节间隙压痛、McMurray试验,其中无症状者59例(88%),关节间隙压痛者5例(7.5%),交锁复发3例(4.5%)。膝关节活动度检查显示,3例伸膝受限大于10°,1例出现止血带麻痹。结论:对于ACL合并内侧半月板红-红区及红-白区BHT,在重建ACL的同时采用关节镜下联合修补技术对BHT的全长范围进行有效修补,在平均40个月的随访期内,可以获得89.5%的总体成功率,包括85%的完全愈合率及4.5%的部分愈合率,失效率为10.4%。

The Therapeutic Effect of Arthroscopic Repair of Bucket-handle Medial Menicus Tear with Combination of Anterior Cruciate Ligament Injury in Knee

Objective Retrospective study of clinical outcome of repairing bucket-handle medial meniscus tears with anterior cruciate ligament(ACL) injury.Methods From May 2002 to Feburary 2007,67 patients with combined repairable bucket-handle medial meniscus tears and ACL injuries were enrolled in this study. Preoperative diagnosis, arthroscopic repair technique, postoperative evaluation and healing influence factors were analyzed, Surgical indications included reducible meniscal tears involving red-red and red-white zone without obvious additional complex tears and tissue degeneration. Surgical procedure included simultaneous anterior cruciate ligament reconstruction and arthroscopic meniscus repair: The anterior and middle 1/3 portion of the lesion was repaired using standard inside-out technique with vertical and interlacing tibial and femoral side arrangement. For repairing the most posterior portion of meniscus,all-inside suture technique with two posterior portals were performed. Results Sixty-seven cases (45 men and 22 women)were available for second-look arthroscopy evaluation on average of 40.6 months (rangeing from 12 to 70 months) postoperatively. Injury-surgery interval was 4 day to 25 years with an average of 26 months. Second-look arthroscopy showed that, 57 of the 67 cases (85%)were completely healed,2 (4.5%)were partially healed,and 7(10.5%)were failed. The overall success rate including completely healed and incompletely healed was 89.6%.Fifty-nine of 67 cases (88%) were asymptomatic clinically. Three cases(4%) had joint line tenderness and 5(7%) had recurrent locking, 3 cases appeared knee extension deficit more than 10 degrees. One had temporary tourniquet paralysis postoperatively.Conclusion For ACL injury combined large bucket-handle meniscus tears involving red-red and red-white zones, arthroscopic combined suture technique together with reconstruction procedure provided reliable suture strength along the whole length of injured region and consequently achieves satisfied anatomical healing with an overall meniscal healing rate of 89.6%. The failure rate was 10.5% during the average of 40-month follow-up period.