半月板撕裂形态能否独立预测修复失败？对500例连续关节镜半月板修复术的背景校正分析
简介
这项回顾性多中心队列纳入500例连续接受初次关节镜半月板修复的患者，随访至少24个月（中位45个月），81例（16.2%）因同侧半月板再手术判定为修复失败，5年修复生存率为82.6%。尽管单因素分析中不同撕裂形态的修复生存存在差异（log-rank P=0.012），但调整患者、半月板及修复相关因素后，撕裂形态不再与失败独立相关；独立预测因素为内侧半月板修复…
英文摘要
PURPOSE: To determine whether meniscal tear morphology independently predicts repair failure following arthroscopic meniscal repair after adjustment for patient-, meniscal- and repair-related characteristics and to quantify the incremental prognostic value of tear morphology beyond established clinical predictors. METHODS: A retrospective multicenter cohort study included 500 consecutive patients undergoing primary arthroscopic meniscal repair with a minimum follow-up of 24 months. Repairable tear morphologies included longitudinal vertical, bucket-handle, radial, horizontal cleavage, complex, ramp and root tears. Patients undergoing revision meniscal repair, previous ipsilateral meniscal repair or transplantation, treatment of discoid meniscus, repair of degenerative root tears associated with advanced osteoarthritis, concomitant corrective osteotomy or arthroplasty or with insufficient operative or follow-up data were excluded. Meniscal characteristics included tear morphology, laterality, vascular zone and intraoperatively assessed tissue quality based on structural integrity, macroscopic degeneration and suture-holding capacity. Repair-related variables included repair technique (all-inside, inside-out or hybrid), number of fixation sutures, suture density and concomitant anterior cruciate ligament reconstruction. Repair failure was defined as subsequent ipsilateral meniscal reoperation. Kaplan-Meier analysis and multivariable Cox proportional hazards regression were used to evaluate repair survival and independent predictors of failure. RESULTS: During a median follow-up of 45 months, 81 patients (16.2%) underwent reoperation. Five-year repair survivorship was 82.6%. Although repair survival differed among tear morphologies in univariable analysis (log-rank p = 0.012), tear morphology was no longer independently associated with failure after multivariable adjustment. Independent predictors of failure included medial meniscal repair (hazard ratio [HR] 2.18), poor tissue quality (HR 2.74), avascular tear location (HR 1.89), lower suture density (HR 0.71 per additional suture/cm) and absence of concomitant anterior cruciate ligament reconstruction (HR 1.67). Addition of tear morphology to the clinical prediction model produced only a modest improvement in discrimination (Harrell's C-index 0.782 vs. 0.794) and minimal improvement in calibration. CONCLUSION: Meniscal tear morphology demonstrated limited independent prognostic value after adjustment for patient-, lesion- and procedure-related characteristics. Prognosis after arthroscopic meniscal repair appears to depend more strongly on the biological and mechanical context of the reparable meniscus than on tear configuration alone. Clinical decision-making should therefore move beyond descriptive tear classification toward comprehensive contextual assessment integrating tissue quality, vascularity, meniscal laterality and repair-related factors. LEVEL OF EVIDENCE: Level III.