关节镜下半月板根部撕裂修复术：当前证据与未来方向
简介
半月板根部撕裂（MRT）是一种特殊类型半月板损伤，具有重要的生物力学和临床影响。根部断裂破坏环箍应力传导，导致功能性半月板切除状态，表现为胫股接触压力增加、半月板进行性外突及关节软骨加速退变，若不治疗将诱发早期骨关节炎。内侧后根部撕裂常见于中年患者，多伴内翻力线和内侧间室负荷过重；外侧根部撕裂常合并前交叉韧带损伤。MRI诊断关键征象包括“鬼影征”、后角截断及…
英文摘要
Meniscal root tears (MRTs) represent a distinct subset of meniscal injuries with profound biomechanical and clinical implications. Disruption of the meniscal root compromises hoop-stress transmission, resulting in a functional meniscectomy state characterized by increased tibiofemoral contact pressures, progressive meniscal extrusion, and accelerated articular cartilage degeneration, ultimately predisposing to early osteoarthritis if left untreated. Medial posterior root tears typically affect middle-aged patients and are commonly associated with varus alignment and medial compartment overload, whereas lateral root tears frequently occur in conjunction with anterior cruciate ligament injuries. Magnetic resonance imaging plays a crucial role in diagnosis, with characteristic findings including the ghost sign, truncation of the posterior horn, and meniscal extrusion of 3 mm or more, while arthroscopy remains the gold standard for definitive assessment of tear morphology and associated intra-articular pathology. Contemporary management has shifted toward joint-preserving strategies, emphasizing anatomic meniscal root repair to restore native biomechanics. Transtibial pull-out techniques and suture-anchor fixation are the most commonly employed methods, with adjunctive procedures such as meniscal centralization and selective biologic augmentation increasingly utilized to enhance healing. In selected cases of symptomatic medial MRTs with varus malalignment, concomitant high tibial osteotomy may be performed to unload the medial compartment and protect the repair. Early recognition and appropriate anatomic repair are essential for optimizing functional outcomes and long-term joint preservation.