与单纯截骨术相比，胫骨高位截骨术配合后内侧半月板根部重建术可获得更好的影像学和功能效果以及愈合率。

IF 4.4 1区医学 Q1 ORTHOPEDICS

Arthroscopy-The Journal of Arthroscopic and Related Surgery Pub Date : 2025-05-01 DOI:10.1016/j.arthro.2024.06.039

Min Lan M.D. , Hongbo Li M.D. , Wentao Dong M.A. , Si Nie M.A. , Xingen Liao M.D. , Jiayu Huang M.A.

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引用次数: 0

摘要

目的：比较接受高胫骨截骨术（HTO）并使用腕骨肌腱移植重建内侧半月板后根撕裂（MMPRT）的患者与未接受MMPRT重建的患者术前和术后的临床和放射学结果：纳入2018年1月至2021年12月期间接受HTO手术且随访至少2年的MMPRT患者。所有患者根据是否接受半月板根重建与肌腱移植分为两组，即单纯 HTO（33 例）和 HTO 与重建 MMPRT（21 例）。临床评估包括 Lysholm 评分、国际膝关节文献委员会（IKDC）评分和视觉模拟量表（VAS）评分。术前和最近一次随访时对膝关节的功能恢复和放射学结果进行了评估。根据第二次核磁共振成像结果，比较两组患者在最近一次随访时的半月板根部愈合率和内侧半月板挤压（MME）情况：结果显示，在最近一次随访中，两组患者的术后 Lysholm 评分、IKDC 评分和 VAS 评分均有统计学意义上的显著改善（PConclusions：使用肌腱移植重建半月板根部的 HTO 与单纯 HTO 相比，可改善放射影像学和患者报告结果，并提高愈合率。

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High Tibial Osteotomy With Medial Meniscal Posterior Root Tear Reconstruction Yields Improved Radiographic and Functional Outcomes and Healing Rates Compared With Osteotomy Alone

Purpose

To compare preoperative and postoperative clinical and radiologic outcomes between patients undergoing high tibial osteotomy (HTO) with medial meniscal posterior root tear (MMPRT) reconstruction using gracilis tendon graft and those undergoing HTO without MMPRT reconstruction.

Methods

Patients with MMPRTs who underwent HTO between January 2018 and December 2021 with minimum 2-year follow-up were included. All patients were divided into 2 groups based on whether they underwent meniscal root reconstruction with tendon graft: HTO alone (33 cases) and HTO with MMPRT reconstruction (21 cases). Clinical evaluation included the Lysholm score, International Knee Documentation Committee (IKDC) score, and visual analog scale (VAS) score. Functional recovery and radiologic outcomes of the knees were evaluated at the latest follow-up. Meniscal root healing rates and medial meniscal extrusion according to a second magnetic resonance imaging reading were compared between the 2 groups at the latest follow-up.

Results

The results showed statistically significant improvements in the postoperative Lysholm score, IKDC score, and VAS score in both groups at the latest follow-up (P < .001). Analysis of the minimal clinically important difference for postoperative outcomes revealed that the percentage of patients who reached the minimal clinically important difference threshold was 100% for the Lysholm score, 100% for the IKDC score, and 100% for the VAS score in the HTO–MMPRT reconstruction group. In comparison, the percentages were 87.9% for the Lysholm score, 90.9% for the IKDC score, and 100% for the VAS score in the HTO-alone group. Additionally, compared with the HTO-alone group, the HTO–MMPRT reconstruction group using gracilis tendon graft showed significantly improved meniscal root healing rates (complete healing, 85.7% vs 45.4% [95% confidence interval, 0.003-0.007]; P = .001) and functional recovery (P < .005) at the final follow-up. Additionally, the HTO–MMPRT reconstruction group showed significantly more improvement in the Kellgren-Lawrence grade (10 of 21 knees vs 6 of 33 knees with improved Kellgren-Lawrence grade, P = .033) and medial meniscal extrusion (2.1 ± 1.0 mm vs 3.1 ± 1.6 mm [95% confidence interval, 0.3-1.7 mm]; P = .007) compared with the HTO-alone group.

Conclusions

HTO with reconstruction of the meniscal root using a tendon graft resulted in improved radiographic and patient-reported outcomes, as well as improved healing rates, compared with HTO alone.

Level of Evidence

Level III, retrospective case-series comparison.

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来源期刊

Arthroscopy-The Journal of Arthroscopic and Related Surgery 医学-外科

CiteScore

9.30

自引率

17.00%

发文量

555

审稿时长

58 days

期刊介绍： Nowhere is minimally invasive surgery explained better than in Arthroscopy, the leading peer-reviewed journal in the field. Every issue enables you to put into perspective the usefulness of the various emerging arthroscopic techniques. The advantages and disadvantages of these methods -- along with their applications in various situations -- are discussed in relation to their efficiency, efficacy and cost benefit. As a special incentive, paid subscribers also receive access to the journal expanded website.