胫骨后倾角减小截骨术可改善ACL重建患者内侧半月板纵裂和桶柄状撕裂的后角愈合效果：一项至少2年随访并二次关节镜探查的研究
简介
一项回顾性队列研究纳入PTS≥15°且前侧胫骨半脱位≥6mm的ACL损伤患者，对比ACL重建联合胫骨后倾角减小截骨术（SRTO）与单纯重建对内侧半月板后角撕裂愈合率的影响。二次关节镜探查显示，SRTO组内侧半月板后角愈合率显著高于对照组（94.1% vs. 70.6%），且不完全愈合与移植物残余松弛相关。对于此类高危患者，附加SRTO有助于促进内侧半月板愈合…
英文摘要
PURPOSE: To assess the effect of additional slope-reducing tibial osteotomy (SRTO) on the healing rate of repaired meniscus posterior horn tears (MPHTs) in ACL-injured patients with steep PTS and excessive anterior tibial subluxation (ATS). METHODS: This retrospective study evaluated patients undergoing primary ACLR between 2016 and 2023 who met three inclusion criteria: PTS ≥ 15°, ATS≥6 mm, and repaired longitudinal and bucket-handle tears involving the meniscus posterior horn. Participants were stratified into an osteotomy group (ACLR + SRTO, n = 20) and a control group (ACLR alone, n = 48), with both cohorts maintaining ≥ 2-year follow-up. The primary endpoint compared meniscal horn healing rates between groups. Second, the associations between meniscal healing status and graft outcomes, as well as postoperative knee stability, were investigated. RESULTS: Both groups were comparable in terms of age, gender, side, BMI, PTS, graft diameter, time from injury to surgery, ATS, KT side-to-side differences, and pivot-shift grade (all P > 0.05). In the osteotomy group, 17 medial meniscus tears were identified (11 longitudinal and 6 bucket-handle tears). At the final follow-up, partial healing of medial MPHTs was achieved in 1 longitudinal tear, resulting in an overall healing rate of 94.1% (16/17). The control group presented with 34 meniscal tears (23 longitudinal + 11 bucket-handle tears). The final follow-up assessment revealed partial healing of medial MPHTs in 8 longitudinal and 2 bucket-handle tears, yielding a significantly lower overall healing rate of 70.6% (24/34) compared with the osteotomy group (P = 0.036). For lateral meniscus tears, the osteotomy group demonstrated partial healing of lateral MPHTs in 1 of 10 cases, compared with 5 of 33 cases in the control group, with no significant difference in overall healing rates between groups (90% vs. 84.8%, P = 0.680). In addition, partial healing of medial MPHTs was associated with residual graft laxity (50% vs. 16.7%, p = 0.045) compared to those with complete healing. CONCLUSION: For ACL-injured patients with steep PTS (≥ 15°) and excessive ATS (≥ 6 mm), the repaired medial MPHTs may benefit from the additional SRTO. In addition, incomplete healing of the posterior horn of the medial meniscus may be associated with residual ACL graft laxity. CLINICAL RELEVANCE: An additional slope-reducing tibial osteotomy may be indicated to facilitate medial meniscal healing in ACL injuries with excessive PTS and a concomitant posterior meniscal horn tear. LEVEL OF EVIDENCE: Cohort study III.