Arthroscopic all-inside suture repair of medial meniscus lesion in anterior cruciate ligament-deficient knees: Results of second-look arthroscopies in 39 cases
Arthroscopic all-inside suture repair of medial meniscus lesion in anterior cruciate ligament-deficient knees: Results of second-look arthroscopies in 39 cases
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DOI：
10.1016/j.arthro.2004.06.038
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发表时间：
2004-11-01
影响因子：
4.7
通讯作者：
Yoo, JC
中科院分区：
文献类型：
--
作者：
Ahn, JH;Wang, JH;Yoo, JC
目的：通过关节镜二次探查，评价使用2个后内侧入路的关节镜全内缝合带钩治疗同时接受前交叉韧带（ACL）重建的患者内侧半月板后角（MMPH）撕裂的临床结果。研究类型：病例系列。研究方法：从1997年5月至2001年6月，78例膝关节接受了MMPH撕裂手术，采用关节镜下全内缝合钩，同时进行ACL重建。其中39例患者接受了随访关节镜二次检查。所有MMPH撕裂均通过关节镜下全内缝合技术使用2个后内侧入路进行修复。平均在ACL重建和踝关节修复后19个月（范围，6至40个月）进行关节镜二次探查。他们被分为完全愈合，不完全愈合和失败组。分析撕裂的大小、类型和位置。我们将半月板状态成功的临床标准确定为：（1）4个临床客观参数（关节线疼痛和压痛、交锁或卡滞、复发性积液和McMurray试验）均不阳性;（2）在关节镜二次检查期间全内缝合半月板完全愈合。结果如下：在39个膝关节的二次关节镜检查中，32个（82.1%）膝关节显示完全愈合，6个（15.4%）膝关节显示不完全愈合，无任何临床症状的阳性结果。此外，不完全愈合组中所有病例的后角均完全愈合，均采用全内缝合;在全内缝合与由内而外缝合的连接区域之间观察到不完全愈合，主要在后内侧角。全内缝合愈合的总体成功率为97.4%（38/39例患者）。1例临床失败的患者（2.6%）修复部位再次撕裂。平均膝关节评分改善，在KT-2000测试中均显示侧侧差异小于2 mm。结论：关节镜下使用缝合钩进行全内垂直缝合，即使是大而复杂的垂直撕裂，愈合率也很高。该手术可作为ACL重建期间MMPH撕裂大于1 cm的最佳治疗方法之一。证据等级：IV级，治疗性研究，病例系列（无，或历史对照组）。
Purpose: To evaluate by second-look arthroscopy the clinical results of arthroscopic all-inside sutures with hook using 2 posteromedial portals for medial meniscus posterior horn (MMPH) tears in patients who underwent concurrent anterior cruciate ligament (ACL) reconstruction. Type of Study: Case series. Methods: From May 1997 to June 2001, 78 knees underwent surgery for MMPH tears with arthroscopic all-inside sutures with hook and concurrent ACL reconstruction. Among them, 39 patients were evaluated with follow-up second-look arthroscopy. All MMPH tears were repaired by arthroscopic all-inside suture technique using 2 posteromedial portals. The second-look arthroscopy was performed, on average, 19 months (range, 6 to 40 months) after the ACL reconstruction and meniscal repair. They were divided into complete healing, incomplete healing, and failure groups. Tear size, type, and location were analyzed. We determined clinical criteria for success in meniscal status as (1) not positive for 4 clinical objective parameters-joint line pain and tenderness, locking or catching, recurrent effusions, and McMurray test; and (2) complete healing of all-inside sutured meniscus during second-look arthroscopy. Results: Among 39 knees assessed by second-look arthroscopy, 32 (82.1%) knees showed complete healing and 6 (15.4%) showed incomplete healing without any positive findings of the clinical symptoms. Furthermore, all cases in the incompletely healed group had complete healing of the posterior horn, which was sutured by an all-inside suture; the incomplete healing was observed between the junction areas of all-inside to inside-out sutures, which was mainly at the posteromedial corner. The success rate was 97.4% (38 of 39 patients) overall for all-inside suture healing. The I patient (2.6%) with clinical failure had a retear of the repaired site. The average knee scores improved and all showed less than 2-mm side-to-side difference on KT-2000 testing. Conclusions: Arthroscopic all-inside vertical suture using a suture hook resulted in a high rate of healing even in large and complex vertical tears. This suturing can be one of the optimal treatments for MMPH tears greater than 1 cm during concurrent ACL reconstruction. Level of Evidence: Level IV, Therapeutic Study, Cases Series (no, or historical, control group).