并非所有半月板修复失败都一样：早期与晚期失败风险因素的比较
简介
该研究基于38,003例半月板修复患者数据，将失败分为早期（<365天）和晚期（≥365天）两种表型。早期失败与女性、桶柄状撕裂、创伤机制、微骨折术、腘绳肌腱自体移植物及单锚钉修复相关（≥3枚锚钉为保护因素）；晚期失败则与膝骨关节炎独立相关，而年龄增长和≥3枚锚钉为保护因素。临床提示：早期失败多源于机械/技术因素，晚期失败更反映关节退变背景，术后监测策略应据…
英文摘要
PURPOSE: Meniscal repair failure is a significant clinical concern, but existing literature treats it as a single outcome without differentiating timing. Early and late failures may represent mechanistically distinct phenomena; identifying their differential predictors could improve risk stratification and postoperative monitoring. METHODS: A retrospective cohort study used a national database to identify patients undergoing arthroscopic meniscal repair, including both isolated repairs and repairs performed with concomitant anterior cruciate ligament reconstruction, classified into early failure (reoperation <365 days, approximating the conventional period of meniscal healing), late failure (≥365 days) or no failure. Cause-specific Cox proportional hazards regression identified independent predictors of each failure type separately. RESULTS: Of 38,003 patients, 3399 (8.9%) experienced failure (1996 early; 1403 late). A bimodal hazard pattern supported phenotypic distinction between groups. Early failure was independently predicted by female sex (hazard ratio [HR] 1.15), bucket-handle tear (HR 1.30), traumatic mechanism (HR 1.14), concomitant microfracture (HR 1.54), hamstring autograft (HR 1.21) and single-anchor repair (HR 1.28); three or more anchors were protective (HR 0.83). Late failure was uniquely predicted by knee osteoarthritis (HR 1.33), whereas increasing age was independently protective (HR 0.98/year) as well as three or more anchors (HR 0.86). Among isolated meniscal repairs, partial meniscectomy was the most common reoperation in both groups, but more frequent in late failures (60.1% vs. 53.7%). Re-repair was more common after early failure (22.5% vs. 16.1%), while TKA was more prevalent after late failure (9.8% vs. 5.4%). All reported associations and between-group differences were statistically significant (p < 0.05). CONCLUSION: Early and late meniscal repair failures are distinct clinical phenotypes with differing risk factors and reoperation patterns. Early failure appears driven by mechanical and technical factors; late failure is more strongly associated with degenerative joint disease and host biology. These findings may inform individualised monitoring and risk stratification strategies. LEVEL OF EVIDENCE: Level III, retrospective cohort study.