对高风险半月板修复术进行纤维蛋白凝块增量可使多达 90% 的病例获得临床愈合。

IF 2.7 Q1 ORTHOPEDICS

Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine Pub Date : 2024-08-30 DOI:10.1016/j.jisako.2024.100316

Peter S.E. Davies, Michael Goldberg, Jon A. Anderson, John Dabis, Andrew Stillwell, Timothy J. McMeniman, Peter T. Myers

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引用次数: 0

摘要

目的：虽然半月板修复术优于半月板切除术，但有些病例如果进行半月板修复，失败的风险可能会更高。有人建议在修复中加入纤维蛋白凝块（FC），以提高愈合率。本研究旨在确定FC增强型半月板修复术的失败率、患者报告结果指标（PROMs）和并发症，这些指标适用于被认为失败风险较高的病例：对2016年1月至2021年9月期间所有接受FC增强型孤立半月板撕裂修复术的患者进行回顾性病例系列研究。所有病例均被认为具有较高的失败风险；其中包括慢性、径向、复杂、水平裂缝以及不在红-红区的撕裂。如果患者同时进行了前交叉韧带（ACL）重建或通过开放切口进行了修复，则排除在外。主要结果是临床失败，即进一步修复或清创。次要结果是 PROMs 和手术并发症。收集的PROM包括Lysholm评分、膝关节损伤和骨关节炎结果评分、牛津膝关节评分和Tegner评分：50名患者（62%为男性）接受了51例FC半月板内外侧修复术。平均年龄为 34 岁（14-70 岁不等）。从受伤到修复的中位时间为122天（4-1565天不等）。63%的病例修复了内侧半月板。撕裂类型包括径向撕裂（31%）和复合撕裂（39%），71%的病例包括白区修复。16%的病例为翻修性半月板修复。研究期间，43%的孤立半月板修复术使用了FC。所有患者的随访时间中位数为46个月（22-87个月）。术后 30 个月中位数的 PROMs 显示，患者的病情有了显著改善。五名患者（10%）在中位 21 个月后因手术失败而接受了进一步手术。两名患者（4%）报告皮肤伤口周围出现感觉障碍，但没有其他并发症报告。13%的内侧半月板修复失败，而只有5%的外侧半月板修复失败（P=0.4）：结论：FC增强型半月板修复术适用于失败风险较高的撕裂，临床失败率较低：证据等级：IV级，病例系列

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Fibrin clot augmentation of high-risk meniscal repairs may result in clinical healing in up to 90% of cases

Objective

While meniscal repair is preferable to meniscectomy, some cases may be at higher risk of failure if repaired. Incorporating fibrin clot (FC) into the repair has been proposed to improve healing rates. The purpose of this study was to determine the failure rates, patient reported outcome measures (PROMs) and complications of FC augmented meniscal repair for cases considered to be at higher risk of failure.

Methods

A retrospective case series of all patients undergoing FC augmented repair of isolated meniscus tears between January 2016 and September 2021 was undertaken. All cases were thought be at higher risk of failure; they included chronic, radial, complex, horizontal cleavage, and tears not in the red–red zone. Patients were excluded if they had a concomitant anterior cruciate ligament (ACL) reconstruction or if the repair was done through an open incision. The primary outcome was clinical failure defined as further repair or debridement. Secondary outcomes were PROMs and surgical complications. PROMs collected were Lysholm score, Knee injury and Osteoarthritis Outcome Score, Oxford Knee Score and the Tegner score.

Results

Fifty one inside-out meniscal repairs using FC were performed in 50 patients (62% male). The mean age was 34 years (range 14–70). The median time from injury to repair was 122 days (range 4–1565). The medial meniscus was repaired in 63% of cases. Tear types included radial (31%) and complex (39%) and 71% of cases included repair of the white–white zone. 16% of cases were revision meniscal repairs. FC was used in 43% of isolated meniscal repairs during the study period. All patients were followed up to a median of 46 months (range 22–87 months). PROMs at a median of 30 months post-operatively showed statistically significant improvements. Five patients (10%) underwent further surgery for failure after median 21 months. Two patients (4%) reported sensory disturbance around their skin wounds, no other complications were reported. 13% of medial meniscal repairs failed, whereas only 5% of lateral meniscal repairs failed (p = 0.4).