高度活跃患者ACL重建后半月板修复可获得与部分半月板切除相当的中期功能表现
简介
该回顾性队列纳入52例高活动度（伤前Tegner≥6）ACL重建合并半月板损伤患者，比较半月板修复（20例）与部分切除（32例）后2–5年的等速肌力、Y平衡、单腿跳及IKDC、Lysholm、ACL-RSI等评分。中期随访显示两组各项客观功能与患者报告结局均无显著差异。提示修复术的早期限制性康复并未造成持续功能缺陷，但样本量小且非随机，术式选择仍应结合长期关…
英文摘要
OBJECTIVE: Concomitant meniscal injuries accompany 40%-60% of anterior cruciate ligament (ACL) ruptures. Surgeons often face a clinical choice between meniscal repair, which prioritizes long-term joint preservation, and partial meniscectomy, which is traditionally perceived to facilitate earlier functional recovery. Despite the biological advantages of repair, persistent concerns remain that its restrictive postoperative protocols might impede mid-term functional performance compared to meniscectomy. This study aims to compare quadriceps/hamstring strength, dynamic balance, functional hop performance, and patient-reported outcomes (PROMs) at 2-5 years post-ACLR between patients undergoing concomitant meniscal repair versus partial meniscectomy. METHODS: This retrospective cohort study evaluated highly active patients who underwent ACLR between 2019 and 2023. Of 68 patients who underwent ACLR with a concomitant meniscal injury and a pre-injury Tegner score ≥ 6,16 were excluded: 5 due to revision ACLR or secondary meniscal procedures during the follow-up period, 8 due to concurrent multi-ligament injuries or full-thickness articular cartilage defects requiring surgery, and 3 due to knee joint deformities (varus or valgus malalignment > 5°)The remaining 52 patients were stratified into meniscal repair (n = 20) or partial meniscectomy (n = 32) groups. Outcomes included isokinetic strength (60°/s, 180°/s; Limb Symmetry Index, LSI), Y-balance test, single-leg hop (SLH), and PROMs (IKDC, Lysholm, and ACL-RSI). RESULTS: At mid-term follow-up (mean 4.1 ± 1.2 years for repair, 4.2 ± 1.2 years for meniscectomy; p = 0.59), no significant differences existed in strength (quadriceps/hamstring LSI 60°/s and 180°/s), dynamic balance (Y-balance), hop tests (SLH, SLCH, and SLTH), or PROMs (all p > 0.05). CONCLUSION: At mid-term follow-up (2-5 years), concomitant meniscal repair yielded objective functional performance and patient-reported outcomes equivalent to partial meniscectomy in highly active patients undergoing ACLR, despite more restrictive early rehabilitation. These findings indicate that the initial postoperative restrictions associated with repair do not result in persistent functional deficits. Although meniscal preservation confers established long-term chondroprotective advantages, the present analysis addresses functional parity only; the surgical strategy should weigh both mid-term function and long-term joint health on an individual basis.