Factors Related to Postoperative Osteochondritis Dissecans of the Lateral Femoral Condyle After Meniscal Surgery in Juvenile Patients With a Discoid Lateral Meniscus
Factors Related to Postoperative Osteochondritis Dissecans of the Lateral Femoral Condyle After Meniscal Surgery in Juvenile Patients With a Discoid Lateral Meniscus
复制标题
DOI：
10.1097/bpo.0000000000001636
复制
发表时间：
2020-10-01
影响因子：
1.7
通讯作者：
Nakamura, Hiroaki
中科院分区：
文献类型：
--
作者：
Hashimoto, Yusuke;Nishino, Kazuya;Nakamura, Hiroaki
目的：探讨青少年盘状外侧半月板手术后剥脱性骨软骨炎(OCD)的发生率及相关流行病学因素。方法：对89例103膝，平均年龄12.1岁的青少年盘状外侧半月板手术病例进行回顾性分析。平均随访时间为4.2年。根据DLm撕裂类型的不同，手术方式有碟状撕裂、碟状修补或半月板次全切除术。术后对强迫症的病变进行放射学鉴定。比较术后诊断为强迫症和非强迫症对照组的年龄、性别、体重、Lysholm评分、Tegner活动评分、运动次数和手术方式。结果：术后诊断为强迫症的膝关节有8/103(7.8%)在DLM术后确诊。单因素分析显示，年龄小于10岁、男性、低体重、Lysholm评分、Tegner活动量表伤前和恢复运动后、每周锻炼次数的患者术后强迫症的发生率显著高于对照组。在多变量分析中，半月板次全切除术后强迫症的发生率高于碟状半月板切除或碟状半月板修补术后，且患者年龄在11岁以下。受试者操作特征曲线分析显示，手术时年龄的临界值为10岁。结论：半月板次全切除术和手术时年龄小于10岁的患者术后发生强迫症的风险更大。为了降低这一风险，如果可能，我们建议在接受DLM手术的患者中进行碟状或碟状修补。
Purpose: The purpose was to assess the incidence of postoperative osteochondritis dissecans (OCD) and the related epidemiologic factors following meniscal surgery for juvenile discoid lateral meniscus (DLM).Methods: The study was a retrospective review of 103 knees in 89 patients with a mean age of 12.1 years who underwent arthroscopic meniscal surgery for DLM. Mean follow-up was 4.2 years. The surgical procedures were either saucerization, saucerization with repair or subtotal meniscectomy, depending on the type of DLM tear. Postoperative OCD lesions were identified radiographically. Age, sex, weight, Lysholm score, Tegner activity scale, exercise frequency, and surgical procedure were compared between the postoperative OCD diagnosis group and non-OCD control group.Results: Postoperative OCD was diagnosed in 8/103 (7.8%) knees following DLM surgery. The incidence of postoperative OCD was significantly greater for patients age less than 10 years old, and male sex, low weight, Lysholm score, Tegner activity scale preinjury and after returning to sports, and exercise frequency per week on univariate analyses. On multivariate analyses, postoperative OCD occurred more commonly with subtotal meniscectomy than with saucerization or saucerization with repair, and in patients less than 11 years of age. Receiver operating characteristic curve analysis revealed a cutoff value of age at surgery of 10 years.Conclusions: Subtotal meniscectomy and patients younger than 10 years at the time of surgery are at greater risk for postoperative OCD. To decrease this risk, if possible, we recommend performing saucerization or saucerization with repair in patients undergoing surgery for DLM.