儿童孤立半月板术后10年创伤后骨关节炎发生率低，且半月板修复术后较半月板切除术后更低。
简介
基于大数据回顾性队列研究，纳入1万余例≤16岁接受半月板修复或切除术的患儿，随访5年及10年发现：切除组创伤性骨关节炎（PTOA）发生率分别为2.2%和2.3%，修复组则更低（1.4%和1.5%）；关节活动度受限后处理操作（MRP）是两组共同的独立危险因素，切除组还与年龄≥12岁及肥胖相关。提示儿童半月板损伤应优先考虑修复，以降低远期PTOA风险。
英文摘要
PURPOSE: To examine the 5- and 10-year incidence of post-traumatic osteoarthritis (PTOA) after isolated, primary meniscal surgery differentiating between meniscal repair and meniscectomy, in pediatric patients. METHODS: Pediatric patients (≤16 years) undergoing primary meniscectomy or meniscal repair (2010-2023) with ≥5-year follow-up were identified in the PearlDiver database. Exclusion criteria included prior or concomitant knee injuries, surgeries, or syndromes. Delayed surgery was defined as ≥90 days after diagnosis. PTOA diagnosis was defined by billing codes. Motion restoration procedures (MRPs) before PTOA diagnosis were recorded. Multivariable logistic and Cox regression were used to assess risk factors for PTOA at 5 and 10 years. RESULTS: A total of 7555 meniscectomy (mean age 14.7, 50% women) and 2797 meniscal repair (mean age 14.4 years, 46% women) patients met inclusion criteria. At 5 years, PTOA occurred in 2.2% of meniscectomy and 1.4% of repair patients. At 10 years, rates were 2.3% and 1.5%, respectively. Average time to PTOA was 737 days (meniscectomy) and 862 days (repair). When disaggregated by sex, there was no significant difference in sex makeup of those who did and did not develop PTOA (P = .430). In the meniscectomy group, risk factors for 10-year PTOA included MRP (hazard ratio [HR] 6.28, P < .001), age ≥12 at surgery (HR 4.84, P = .027), and obesity (HR 1.84, P < .001). In the repair group, MRPs (HR 5.23, P = .023) and depression (HR 2.02, P = .027) were significant. These same risk factors were identified for 5-year PTOA. CONCLUSIONS: The 10-year incidence of PTOA was 2.2% after meniscectomy and 1.5% after meniscal repair in pediatric patients. MRPs were a consistent risk factor. Age ≥12 and obesity were associated with PTOA after meniscectomy. Depression was associated with PTOA after repair. LEVEL OF EVIDENCE: Level III, retrospective cohort study.