非手术治疗内侧半月板后根撕裂后尽管结构退化但临床改善：一项前瞻性纵向研究
简介
一项针对急性内侧半月板后根撕裂（MMPRT）非手术治疗患者的前瞻性队列研究（平均发病年龄65.6岁，Ⅱ级证据）显示，多数患者6个月内临床症状显著改善（NRS自7.6降至1.3），但K-L分级、关节间隙及半月板外突出等结构退化持续加重。15例（23.4%）在6个月后转手术，基线内翻力线（HKA≥5.5°）是预测转手术的独立因素（AUC 0.742）。该结果提示…
英文摘要
PURPOSE: To longitudinally evaluate clinical, radiographic and magnetic resonance imaging (MRI) changes in patients with medial meniscus posterior root tear (MMPRT) managed nonoperatively and to identify factors associated with patient-driven conversion to surgery. METHODS: A prospective longitudinal study was conducted in patients with acute MMPRT (≤3 months from symptom onset) who opted for nonoperative treatment during 2017-2024. Patients with <2 years of follow-up, chronic tears (>3 months) or Kellgren-Lawrence (K-L) grade ≥3 were excluded. Clinical outcomes (Numerical Rating Scale [NRS] and Knee injury and Osteoarthritis Outcome Score [KOOS]), radiographic parameters (K-L grade, hip-knee-ankle angle [HKA] and medial joint space width) and MRI findings (medial meniscus extrusion and full-thickness cartilage defect length on coronal images) were assessed. Baseline factors were compared between patients who continued nonoperative treatment and those who elected to undergo surgery. RESULTS: Sixty-four patients (mean age at onset, 65.6 years) were included. Nonoperative treatment was continued in 49 patients (76.6%); 15 (23.4%) converted to surgery after a median of 6 months (interquartile range, 3-8 months). Clinical outcomes improved significantly within 6 months (NRS, 7.6 ± 2.4 to 1.3 ± 1.2; KOOS symptom, 64.0 ± 13.0 to 79.1 ± 10.8; p < 0.05) and remained stable. Conversely, structural degeneration progressed early: The K-L grade worsened (Grade 0, 28-11 cases), joint space narrowed (3.5 ± 0.8 to 2.9 ± 0.7 mm) and meniscal extrusion progressed (3.1 ± 1.0 to 4.3 ± 1.3 mm) within 6 months (p < 0.05). Femoral and tibial cartilage loss also progressed within 1 year (femoral, 3.2 ± 3.5 to 6.9 ± 3.8 mm; tibial, 0.6 ± 1.9 to 2.6 ± 3.6 mm; p < 0.05). Baseline varus alignment was greater in patients who underwent surgery than in those who continued nonoperative treatment (HKA, 6.0° vs. 3.7°, p < 0.01). Receiver operating characteristic analysis identified an HKA threshold of 5.5° for predicting conversion to surgery (area under the curve, 0.742). CONCLUSION: Most patients with MMPRT managed nonoperatively showed clinical improvement despite early structural deterioration. Varus alignment was associated with patient-initiated conversion to surgery, and an HKA threshold of 5.5° may help identify patients at increased risk of conversion to surgery. These findings highlight a critical clinical paradox and support alignment-based decision-making in MMPRT management. LEVEL OF EVIDENCE: Level II, study design: prospective cohort.