Increased extrusion and ICRS grades at 2-year follow-up following transtibial medial meniscal root repair evaluated by MRI
Increased extrusion and ICRS grades at 2-year follow-up following transtibial medial meniscal root repair evaluated by MRI
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DOI：
10.1007/s00167-017-4755-8
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发表时间：
2018-09-01
影响因子：
3.8
通讯作者：
Alaia, Michael J.
中科院分区：
文献类型：
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作者：
Kaplan, Daniel J.;Alaia, Erin F.;Alaia, Michael J.
本研究的目的是评估半月板根修复手术的短期效果，评估临床和影像学结果，利用MRI评估根愈合和术后挤压程度。方法：本研究是一项单中心、回顾性研究，评估采用经胫骨拔出技术和两根锁紧缝合线进行内侧半月板后根修复的患者。从患者图表中收集人口统计数据。临床结果通过术前和术后IKDC和Lysholm评分进行评估。术前评分在患者首次就诊时进行，平均在手术前1.55个月（±1.8个月，最小0.3，最大7.3）。影像学结果通过MRI评估牙根愈合、半月板挤压和软骨退变采用ICRS标准进行评估。评估隧道位置并与解剖足迹进行比较。结果18例患者（47.2岁+/- 11.9岁）平均随访24.9个月（+/- 7.2个月，最短18.4个月，最长35.6个月）。IKDC评分由术前的45.9分（+/- 12.6分）上升至术后的76.8分（+/- 14.7分），差异有统计学意义（p < 0.001）。Lysholm评分也从50.9（+/- 7.11）上升到87.1 (+/- 9.8)（p < 0.001）。平均隧道放置距离解剖足迹5.3 mm（±3.5，范围0-11.8）。平均挤压从术前4.74 mm（+/- 1.7）增加到术后5.98 mm (+/- 2.8) （p < 0.02）。术前MRI显示bbb30 mm挤压的患者，术后MRI均无< 3 mm挤压。股骨内侧髁和胫骨内侧平台ICRS评分均显著恶化（p < 0.02和p < 0.01）。MRI显示，1例牙根完全愈合，16例部分愈合，1例未愈合。结论经胫间带两根锁扣缝线拔除术可改善患者的临床疗效，但多数病例仅部分愈合，挤压加重，随访MRI显示内侧间室软骨缺损等级加重。患者应被告知，虽然短期的临床结果可能是乐观的，但关于退行性关节炎进展的长期结果可能无法预测。
Purpose The purpose of the current study was to evaluate the short-term results of meniscal root repair surgery, assessing clinical and radiographic outcomes, utilizing MRI to assess root healing and extent of post-operative extrusion.Methods This was a single-center, retrospective study evaluating patients who had undergone a medial meniscus posterior root repair using a transtibial pullout technique with two locking cinch sutures. Demographic data were collected from patient charts. Clinical outcomes were assessed with pre- and post-operative IKDC and Lysholm scores. Preop scores were taken at the patients' initial clinical visit, mean 1.55 months prior to surgery (+/- 1.8 months, min 0.3, max 7.3). Radiographic outcomes were assessed with MRI evaluation of root healing, meniscal extrusion, and cartilage degeneration using ICRS criteria. Tunnel placement was evaluated and compared to the anatomic footprint.Results Eighteen patients (47.2 years +/- 11.9) were evaluated at mean follow-up of 24.9 months (+/- 7.2, min 18.4, max 35.6). The IKDC score significantly increased from 45.9 (+/- 12.6) pre-operatively to 76.8 (+/- 14.7) post-operatively (p < 0.001). Lysholm scores also increased from 50.9 (+/- 7.11) to 87.1 (+/- 9.8) (p < 0.001). Mean tunnel placement was 5.3 mm (+/- 3.5, range 0-11.8) away from the anatomic footprint. Mean extrusion increased from 4.74 mm (+/- 1.7) pre-operatively to 5.98 (+/- 2.8) post-operatively (p < 0.02). No patients with > 3 mm of extrusion on pre-operative MRI had < 3 mm of extrusion on post-operative MRI. Both medial femoral condyle and medial tibial plateau ICRS grades worsened significantly (p < 0.02 and p < 0.01, respectively). On MRI, one root appeared completely healed, 16 partially healed, and one not healed.Conclusion Patients treated with the transtibial suture pull-out technique with two locking cinch sutures had improved clinical outcomes, but only partial healing in the majority of cases, increased extrusion, and progression of medial compartment cartilage defect grade on follow-up MRI. Patients should be counseled that although clinical outcomes in the short term may be optimistic, long-term outcomes regarding progression to degenerative arthritis may not be as predictable.