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中华老年骨科与康复电子杂志

中华老年骨科与康复电子杂志 ›› 2024, Vol. 10 ›› Issue (01) : 19 -27. doi: 10.3877/cma.j.issn.2096-0263.2024.01.004

关节

外侧半月板后根修复对前交叉韧带重建后膝关节稳定性的影响
陈博1, 王庆帅1, 张智乘1, 李颖智1,†()   
  1. 1. 130000　吉林大学第二医院运动医学与关节镜科
  • 收稿日期:2023-08-28 出版日期:2024-02-05
  • 通信作者: 李颖智
  • 基金资助:
    国家自然科学基金(U21A20390)

The effect of lateral meniscus posterior root repair on the stability of anterior cruciate ligament reconstructed knee

Bo Chen1, Qingshuai Wang1, Zhicheng Zhang1, Yingzhi Li1,†()   

  1. 1. Department of Sports Medicine and Arthroscopy, Second Hospital of Jilin University, Changchun 130000, China
  • Received:2023-08-28 Published:2024-02-05
  • Corresponding author: Yingzhi Li
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陈博, 王庆帅, 张智乘, 李颖智. 外侧半月板后根修复对前交叉韧带重建后膝关节稳定性的影响[J]. 中华老年骨科与康复电子杂志, 2024, 10(01): 19-27.

Bo Chen, Qingshuai Wang, Zhicheng Zhang, Yingzhi Li. The effect of lateral meniscus posterior root repair on the stability of anterior cruciate ligament reconstructed knee[J]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2024, 10(01): 19-27.

目的

评估外侧半月板后根修复或部分切除对前交叉韧带（ACL）重建后膝关节稳定性的影响是否存在差异。

方法

回顾性收集2018年6月至2022年3月经关节镜诊断为ACL撕裂合并外侧半月板后根撕裂（LMPRT）的患者，根据不同术式分为2组，A组行ACL重建+LMPR修复；B组行ACL重建+LMPR部分切除术。此外，随机匹配同时期单纯ACL撕裂行ACL重建患者作为对照组（C组）。所有患者随访12个月以上。根据Lysholm评分、国际膝关节评分委员会（IKDC）评分评估膝关节客观功能，通过轴移试验、基于MRI测量的胫骨前半脱位（ATS）、外侧半月板外突（LME）、胫骨结节-滑车沟（TT-TG）间距、股骨胫骨旋转（FTR）角评估膝关节稳定性。

结果

共纳入患者45例，男性30例，女性15例，平均年龄（33.98±11.00）岁，随访时间（14.54±1.88）个月。与术前相比，末次随访时各组患者Lysholm评分、IKDC评分、ATS、TT-TG与FTR结果均显著改善（P<0.05）；A组末次随访时LME与术前相比存在显著改善（P<0.05）。组间比较：（1）术前，C组的Lysholm评分、IKDC评分、轴移试验结果、ATS、LME等指标显著优于A、B两组（P<0.05）；各组TT-TG和FTR无显著差异（P>0.05）。（2）术后，B组轴移试验显著强于A、C两组（P<0.05），A、C两组的轴移试验无显著差异（P>0.05）。（3）末次随访时，A、C两组的自主功能评分和LME均显著优于BB组（P<0.05）；B组ATS显著高于C组（P<0.05）；A组与C组患者自主功能评分、ATS、LME均无显著差异（P>0.05）；各组TT-TG与FTR无显著差异（P>0.05）。

结论

LMPRT修复可进一步提高ACL重建后膝关节的前向和旋转稳定性，并减少LME，提高患者自主功能评分。

关键词: 外侧半月板后根撕裂, 前交叉韧带撕裂, 胫骨前半脱位, 半月板外突, 胫骨结节-滑车沟间距
Objective

This study was to investigate the effect of stability of the anterior cruciate ligament (ACL)-reconstructed knee between lateral meniscus posterior root (LMPRT) repair and partial meniscectomy.

Methods

The patients with ACL tear and LMPR injury were enrolled in this study (group A: ACL reconstruction+LMPR repair, 17 patients; group B: ACL reconstruction+LMPR partial meniscectomy, 10 patients). At the same time, the patients who underwent ACL reconstruction for simple ACL tear were randomly matched as the control group (group C). All patients had at least 12-month follow-up. Lysholm score and International Knee Documentation Committee (IKDC) score were used to assess the knee function of the patients. The physical examination was assessed using the pivot shift test. Anterior tibial subluxation (ATS), lateral meniscal extrusion (LME), Tibial Tubercle-Trochlear Groove (TT-TG) distance, femorotibial rotation (FTR) angle, and the lateral compartment cartilage of the knee were assessed via magnetic resonance imaging (MRI).

Results

A total of 45 patients were enrolled in this study, with 30 males and 15 females, and an average age of (33.98±11.00) years. The follow-up period was (14.54±1.88) months. Compared to the preoperative measurements, at the latest follow-up, patients in all groups demonstrated significant improvements in Lysholm scores, IKDC scores, ATS, TT-TG, and FTR results (P<0.05). There was a significant difference in the degree of preoperative LME in group A patients compared with the values of the last follow-up (P<0.05). Intergroup comparison: (1) Preoperatively, there were significant differences in Lysholm score, IKDC score, pivot shift test, ATS, and LME in group C compared with groups A and B (P<0.05), and there was no significant difference in TT-TG and FTR in each group (P>0.05). (2) Postoperatively, there was a significant difference in the results of the pivot shift test in group B compared with groups A and C (P<0.05), and there was no significant difference in the results of the pivot shift test between groups A and C (P>0.05). (3) At the last follow-up, there were significant differences in the patient-reported scores and LME in group B compared with groups A and C (P<0.05). There was a significant difference between group B and group C in ATS, and there was no significant difference between group A and group C in patient-reported scores, ATS, and LME (P>0.05). There was no significant difference in TT-TG and FTR in each group (P> 0.05).

Conclusions

LMPRT repair further improves the anterior and rotational stability of the ACL-reconstructed knee, leading to reduced the LME, and improves the patient-reported scores.

Key words: Lateral meniscal posterior root tear, Anterior cruciate ligament tear, Anterior tibial subluxation, Meniscal extrusion, Tibial tubercle-trochlear groove distance
表1 外侧半月板后根撕裂患者人口统计学特征比较结果
组别 例数 年龄（岁，±s） 性别（例，男/女） BMI（kg/m2，±s） 随访时间（月，±s）
A组 17 32.41±10.97 4/13 25.95±3.57 14.68±1.95
B组 10 32.00±10.34 7/3 25.80±5.34 13.98±1.75
C组 18 36.56±11.45 10/8 25.00±2.54 14.71±1.93
F值   0.822   0.319 0.553
P值   0.446 0.410 0.728 0.579
图1　ATS移位测量方法示意图　 图2　LME程度测量方法示意图　 图3~4　TT-TG测量方法示意图
图5~6 FTR角度测量方法示意图
图7~10 LMPRT或修复后术中图像。图7　LaPrade 2型全内缝合术中图像；图8　LaPrade 3型损伤术中图像；图9　LaPrade 4型损伤术中图像；图10　LaPrade 5型经胫骨隧道拉出固定术中图像；
图11~13 LMPRT修复外侧半月板后根撕裂患者随访MRI。图11　LMPR牵拉固定胫骨隧道（灰色箭头）；图12　ACL移植物胫骨隧道（黑线箭头）和LMPR牵拉固定胫骨隧道（灰色箭头）；图13　缝合LMPR所用的Fast-Fix植入物（白色箭头）
表2 纳入外侧半月板后根撕裂患者LMPRT类型（例）
LaPrade分型 A组 B组 C组
2型 4 2 0
3型 5 3 0
4型 5 4 0
5型 3 1 0
图14　手术前后各组外侧半月板后根撕裂患者之间的Lysholm评分结果　 图15　手术前后各组外侧半月板后根撕裂患者之间的IKDC评分结果　 图16　术前及末次随访时的组间ATS对比结果　 图17　术前及末次随访时的组间LME对比结果
表3 各组外侧半月板后根撕裂患者自主功能评分结果比较（分，±s）
组别 例数 术前 末次随访 t值 P值
Lysholm评分          
A组 17 28.76±6.61 95.18±4.30 -33.669 <0.001
B组 10 28.60±7.03 88.40±4.81 -18.200 <0.001
C组 18 36.89±7.19 98.39±2.72 -38.508 <0.001
IKDC评分          
A组 17 31.47±4.16 88.47±4.23 -41.633 <0.001
B组 10 30.70±4.67 81.00±5.25 -24.160 <0.001
C组 18 35.67±4.31 91.11±3.27 -44.248 <0.001
表4 手术前后各组外侧半月板后根撕裂患者的轴移试验结果比较[例（%）]
轴移试验 A组（n=17） B组（n=10） C组（n=18）
术前 术后 术前 术后 术前 术后
0级 0（0.0） 11（64.7） 0（0.0） 3（30.0） 0（0.0） 14（77.8）
Ⅰ级 0（0.0） 4（23.5） 0（0.0） 2（20.0） 8（44.4） 4（22.2）
Ⅱ级 3（17.6） 2（11.8） 2（20.0） 5（50.0） 4（22.2） 0（0.）
Ⅲ级 14（82.4） 0（0.0） 8（80.0） 0（0.0） 6（33.3） 0（0.0）
χ2值 29.200 14.286 25.333
P值 <0.001 0.001 <0.001
表5 术前及术后各组外侧半月板后根撕裂患者轴移试验结果比较
χ2；P值 术前 术后
A组：B组 0.023；1.000 5.048；0.091
A组：C组 11.324；0.002 2.333；0.521
B组：C组 7.259；0.021 11.432；0.003
表6 各组外侧半月板后根撕裂患者ATS测量结果统计学分析（mm，±s）
组别 术前ATS 末次随访ATS t值 P值
A组 5.65±1.52 1.72±1.60 7.724 0.001
B组 5.82±1.68 2.55±1.34 9.935 0.047
C组 4.30±1.56 1.04±1.16 9.506 0.001
F/H 4.416 11.338    
P值 0.018 0.003    
表7 各组外侧半月板后根撕裂患者LME测量结果统计学分析（mm，±s）
组别 术前LME 末次随访LME t/Z值 P值
A组 3.08±0.70 1.18±0.45 7.979 <0.001
B组 3.22±0.55 3.17±0.92 0.264 0.959
C组 0.89±0.69 0.77±0.62 -1.915 0.055
F/H值 61.050 25.478    
P值 <0.001 <0.001    
表8 各组外侧半月板后根撕裂患者TT-TG测量结果统计学分析（mm，±s）
组别 术前TT-TG 末次随访TT-TG t值 P值
A组 13.70±1.20 10.58±1.72 6.275 <0.001
B组 13.64±1.16 11.12±1.70 5.000 0.001
C组 12.76±1.47 10.29±1.17 6.008 <0.001
F值 2.648 0.955    
P值 0.083 0.393    
表9 各组外侧半月板后根撕裂患者FTR角度结果统计学分析（°，±s）
组别 术前FTR角 末次随访FTR角 t/Z值 P值
A组 4.24±3.37 -1.05±3.42 -3.148 <0.001
B组 3.92±3.75 -1.08±3.14 3.156 <0.001
C组 3.65±4.25 -1.36±3.12 -2.591 <0.001
H值 0.031 0.040    
P值 0.899 0.958    
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