Mid-term study on the effects of arthroscopic discoid lateral meniscus plasty on patellofemoral joint: An observational study.
Mid-term study on the effects of arthroscopic discoid lateral meniscus plasty on patellofemoral joint: An observational study.
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关节镜下盘状外侧半月板成形术对髌股关节影响的中期观察性研究
DOI：
10.1097/md.0000000000031760
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发表时间：
2022-11-11
期刊：
影响因子：
1.6
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中科院分区：
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在本研究中，我们旨在探讨关节镜下盘状外侧半月板（DLM）成形术的临床结果以及术后髌股关节的适应性变化。 2010年9月至2012年3月，25例接受关节镜下半月板成形术的DLM损伤患者被纳入该前瞻性研究。所有患者术前及末次随访时均进行临床评估，术前、术后1个月及末次随访时采用直立式磁共振成像进行影像学评估。临床评估包括Lysholm评分、Kujala评分、McMurray征、髌骨活动度、髌骨研磨试验和股四头肌萎缩。影像学评估包括平分偏移指数、髌骨倾斜角（PTA）和软骨损伤。末次随访时Lysholm评分、Kujala评分、McMurray征、股四头肌萎缩情况较术前显着改善（P < .05）。末次随访时髌骨活动度及髌骨研磨试验与术前相比无统计学差异。此外，平分偏移指数和PTA随时间的推移呈现先升后降的动态趋势（P < .05）。术后1个月，平分偏移指数和PTA较术前或末次随访时显着升高（P < .05），而术前与末次随访时无差异。软骨损伤随时间延长而加重（P < 0.05），且两者呈正相关（Spearman = 0.368）。末次随访时软骨损伤程度较术前显着加重（P < .017），而术后1个月分级与术前或末次随访分级无显着性差异。关节镜下DLM成形术对髌股关节的影响是动态的，早期髌骨位置偏离，中期恢复，尤其是当膝关节处于生物力学站立位时。另外，术后髌股关节软骨可能会加速退变，但手术中期效果良好，髌股关节功能尚可。
In the present study, we aimed to investigate the clinical outcomes of arthroscopic discoid lateral meniscus (DLM) plasty and the adaptive changes in the patellofemoral joint after surgery. From September 2010 to March 2012, 25 patients with DLM injuries who underwent arthroscopic meniscus plasty were enrolled in the prospective study. All patients underwent clinical evaluation before the operation and at the last follow-up, and imaging evaluation was performed by upright magnetic resonance imaging before and 1 month after the operation as well as at the last follow-up. Clinical evaluation included Lysholm score, Kujala score, McMurray’s sign, patellar mobility, patella grind test, and quadriceps atrophy. Imaging evaluation included bisect offset index, patella tilt angle (PTA), and cartilage damage. Lysholm score, Kujala score, McMurray’s sign, and quadriceps atrophy at the last follow-up were significantly improved compared with the preoperative levels (P < .05). At the last follow-up, there were no statistical differences in patella mobility and patella grind test compared with the preoperative levels. In addition, bisect offset index and PTA showed a dynamic trend of rising and then falling over time (P < .05). At 1 month after the operation, bisect offset index and PTA were significantly increased compared with the preoperative levels or the values at the last follow-up (P < .05), while there were no differences between the preoperation and the last follow-up. Cartilage damage became worse with time (P < 0.05), and the 2 were positively correlated (Spearman = 0.368). At the last follow-up, the degree of cartilage damage was significantly increased compared with the preoperative level (P < .017), while there was no significant difference between the 1-month postoperative grade and the preoperational grade or the last follow-up grade. The effect of arthroscopic DLM plasty on the patellofemoral joint was dynamic, with the position of the patella deviating in the early stages and recovering in the mid-term, especially when the knee was in the biomechanical standing position. In addition, the patellofemoral joint cartilage might undergo accelerated degeneration after the operation, while the mid-term effect of the operation was positive, and the patellofemoral joint function was acceptable.