斜坡损伤的形态和功能变异性影响前交叉韧带重建术中的手术处理：法国关节镜学会全国注册研究
简介
基于法国关节镜学会多中心注册数据，纳入449例ACL重建合并ramp lesion患者，分析Thaunat分型、半月板活动度与修复策略的关联。结果显示：79.7%存在病理性活动度，分型与活动度异常及缝合数量显著相关，后内侧缝合钩技术占77.7%。提示Thaunat分型可作为制定损伤特异性修复策略的参考依据。
英文摘要
PURPOSE: The purpose of this study was to describe current arthroscopic diagnostic and repair practices for ramp lesions during anterior cruciate ligament reconstruction and to evaluate the association between the Thaunat classification, meniscal mobility and surgical repair strategy. METHODS: A multicenter descriptive study was performed using data from the prospective French Arthroscopy Society registry. Patients undergoing anterior cruciate ligament reconstruction with an associated ramp lesion were included. Demographic data, mechanism of injury, delay to surgery, arthroscopic diagnostic technique, lesion type (Thaunat classification), meniscal mobility, lesion length, repair technique, number of sutures and surgical approach were recorded. Associations between lesion type, meniscal mobility and number of sutures were analysed. RESULTS: A total of 449 patients were included (69.3% male, mean age 25.4 ± 8.4 years). Sports trauma accounted for 91.5% of cases. Ramp lesion diagnosis was achieved primarily through intercondylar view alone (46.5%) or intercondylar view combined with posteromedial probing (41.9%). Lesion type according Thaunat were Type 1 (43.0%), Type 2 (7.8%), Type 3 (20.7%), Type 4 (21.2%) and Type 5 (7.3%). Meniscal mobility was pathological (defined as abnormal displacement of the posterior horn during probing without or with condylar overpass) in 79.7% of cases and a significant association was found between lesion type and pathological meniscal mobility (p < 0.01). Repair was with a posteromedial hook technique in 77.7%. Lesion type was significantly associated with the number of sutures (p < 0.01). CONCLUSION: Ramp lesions demonstrate substantial morphological variability associated with different patterns of meniscal mobility. The Thaunat classification correlates with meniscal mobility and surgical strategy in this univariate analysis. Repair using a suture hook through a posteromedial portal remains the predominant technique in France. These findings may contribute to a more standardised, lesion-specific approach to the diagnosis and repair of ramp lesions during ACL reconstruction. LEVEL OF EVIDENCE: Level III.