内侧半月板后根部撕裂合并局灶性软骨损伤可通过拉出修复联合骨髓刺激术成功治疗
简介
本研究回顾性评估了内侧半月板后根撕裂（MMPRT）合并局灶软骨损伤患者接受经胫骨隧道pullout修复联合微骨折术（MF组，10例）与单纯pullout修复（P组，37例）的疗效。两组患者基线资料、影像学参数（力线、股胫角）无显著差异。术后1年和3年随访，MF组KOOS、IKDC、Tegner、Lysholm及疼痛VAS评分均较术前显著改善，二次关节镜探查证…
英文摘要
BACKGROUND/OBJECTIVE: Although many studies have reported the clinical outcomes of pullout repair for medial meniscus posterior root tears (MMPRTs) or microfractures for focal cartilage lesions alone, no study has specifically reported the clinical outcomes in patients with MMPRT combined with cartilage lesions. Therefore, we investigated the effectiveness of bone marrow stimulation via microfracture for treating focal cartilage lesions associated with MMPRT and compared the clinical outcomes between patients who underwent microfracture and those who did not. We hypothesised that favourable clinical outcomes could be achieved after transtibial pullout repair combined with microfracture for MMPRTs with focal cartilage lesions and that these outcomes would be comparable to those after transtibial pullout repair alone for MMPRTs without cartilage lesions. METHODS: Ten patients who underwent transtibial pullout repair and microfracture for MMPRT with cartilage lesions (Group MF) and 37 patients who underwent only pullout repair for MMPRT without cartilage lesions (Group P) using the same pullout technique (two simple stitches) as Group MF between November 2016 and September 2023 were retrospectively evaluated. The age at the time of surgery, sex, height, weight, body mass index, duration from injury to surgery, and KL grade were recorded for each patient. The presence, location, and area of cartilage lesions were evaluated. Clinical outcomes were assessed, and all included patients underwent a second-look arthroscopy. RESULTS: The mean follow-up period, patient age, body mass index, femorotibial angle, and percentage of the mechanical axis in Group MF were 3.2 years, 60.2 years, 26.1 kg/m2, 176.3°, and 42.4%, respectively. All postoperative clinical outcomes at one and three years showed significant improvement compared with preoperative outcomes, including the KOOS and IKDC, Tegner, Lysholm, and pain VAS scores. Second-look arthroscopy confirmed good meniscal healing. No significant differences in demographic data, radiological parameters, clinical outcomes, or meniscal healing were observed between Groups MF and P, both preoperatively and at the three-year postoperative follow-up. CONCLUSION: The clinical outcomes of transtibial pullout repair combined with microfracture were favourable in patients with MMPRT and focal cartilage lesions in well-aligned knees. Moreover, no significant differences in clinical outcomes were detected between patients who underwent pullout repair combined with microfracture and those who underwent pullout repair alone. MMPRTs with focal cartilage lesions may be effectively treated with pullout repair combined with microfracture, provided that strict patient selection criteria are applied.