内侧半月板后根撕裂的外伤性发病与年轻有关，而隐性发病与慢性负荷和骨挫伤有关

Q3 Medicine

Arthroscopy Sports Medicine and Rehabilitation Pub Date : 2025-06-01 DOI:10.1016/j.asmr.2025.101118

Rodrigo Saad Berreta B.A. , Lucas Pallone M.D. , Enzo S. Mameri M.D. , Felipe Gonzalez M.D. , Jared Rubin B.A. , Ashwinee Manivannan B.Sc. , Juan Bernardo Villarreal-Espinosa M.D. , Salvador Ayala B.S. , José Rafael Gracia B.S. , Felicitas Allende M.D. , Nikhil N. Verma M.D. , Jorge Chahla M.D., Ph.D.

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引用次数: 0

摘要

目的评价内侧半月板后根撕裂（MMPRTs）的临床和影像学表现，探讨其与外伤性和隐匿性病因的关系。方法回顾性分析2019年至2023年由一名奖学金培训的外科医生接受关节镜孤立MMPRT修复的患者。临床变量包括病史（HPI）、病史和体格检查结果。影像学变量包括Kellgren-Lawrence分级、骨挫伤、鬼影征、截断征、垂直于半月板的线性高强度、半月板挤压、胫骨斜率和机械轴。将患者按诱发性事件和潜伏性事件分层进行亚组分析。结果72例患者（平均年龄56.7±8.9岁，平均体重指数32.3±5.7 k/m2）中，45.8%的患者报告了刺激事件的回忆。HPI最常见的表现是膝关节肿胀（72.2%），其次是机械症状（62.5%）和感觉不稳定发作（45.8%），而内侧关节线压痛（93.1%）和McMurray试验阳性（69.4%）在体格检查中常见。在MRI上，91.7%的病例发现了鬼征，其次是截断征（83.3%）和垂直于半月板的线性信号（68.1%）。测量的平均半月板挤压为4.18±1.09 mm。有煽动性事件的病例更可能是年轻（P = 0.021）、急性发作（P = 0.039）和McMurray试验阳性（P = 0.036）。隐匿性表现的病例在股骨内侧髁（P = 0.016）和内侧平台（P = 0.029）处有较高的骨挫伤发生率。结论：伴有刺激事件的MMPRT患者通常较年轻，更有可能出现急性发作，McMurray试验呈阳性。相反，隐匿性表现的患者年龄较大，长期存在，表现出较高的骨挫伤率，特别是当有内翻错位时。证据级别：IV级，预后病例系列。

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Traumatic Onset of Medial Meniscus Posterior Root Tears Is Associated With Younger Age While Insidious Onset Is Associated With Chronic Overload and Bone Bruising

Purpose

To evaluate clinical and radiographic findings for medial meniscus posterior root tears (MMPRTs) and investigate their associations with traumatic and insidious etiologies.

Methods

Patients who underwent arthroscopic isolated MMPRT repair by one fellowship-trained surgeon from 2019 to 2023 were retrospectively identified. Clinical variables included history of present illness (HPI), medical history, and physical examination findings. Radiographic variables included Kellgren-Lawrence grade, bone bruise, ghost sign, truncation sign, linear hyperintensity perpendicular to the meniscus, meniscal extrusion, tibial slope, and mechanical axis. Patients were stratified by inciting event versus insidious onset for subgroup analysis.

Results

Of 72 patients (mean age 56.7 ± 8.9 years, mean BMI 32.3 ± 5.7 k/m²), recollection of an inciting event was reported in 45.8% of patients. The most prevalent findings in the HPI were knee swelling (72.2%) followed by mechanical symptoms (62.5%) and episodes of perceived instability (45.8%), whereas medial joint line tenderness (93.1%) and a positive McMurray’s test (69.4%) were commonly observed on physical examination. On MRI, ghost sign was identified in 91.7% of cases followed by truncation sign (83.3%) and a linear signal perpendicular to the meniscus (68.1%). The average measured meniscal extrusion was 4.18 ± 1.09 mm. Cases with an inciting event were more likely to be younger (P = .021), present acutely (P = .039), and have a positive McMurray test (P = .036). Cases with an insidious presentation were found to have higher rates of bone bruising at the medial femoral condyle (P = .016) and medial plateau (P = 0.029).

Conclusions

Patients with MMPRT associated with an inciting event are typically younger and more likely to present acutely, with a positive McMurray’s test. Conversely, patients with insidious presentation are older, present chronically, and exhibit higher rates of bone bruising, particularly when there is varus malalignment.