Background:

Meniscus root tears lead to de-tensioning of the meniscus, increased contact forces, and cartilage damage. Management of older patients with root tears is controversial and the efficacy of different treatment options is unclear.

Purpose:

To compare the clinical outcomes of patients with moderate knee osteoarthritis who underwent an all-inside meniscus root repair technique versus nonoperative management for either medial or lateral meniscus root tears.

Study Design:

Cohort study; Level of evidence, 2.

Methods:

Patients with a diagnosed posterior meniscus root tear who underwent arthroscopic repair (AR: 30 knees) or nonoperative treatment with observation (O: 18 knees) were followed for a minimum of 2 years (mean follow-up, 4.4 years). The arthroscopic repair included all-inside sutures to reduce the root back to its remnant (reduction sutures), thereby re-tensioning the meniscus, and 1 mattress suture to strengthen the repair by reapproximating the construct to the posterior capsule. The data collected included the Knee injury and Osteoarthritis Outcome Score (KOOS), Lysholm, Tegner, and Veterans RAND 12-Item Health Survey (VR-12) Physical Component Summary (PCS) and Mental Component Summary (MCS) scores and conversion to total knee arthroplasty (TKA).

Results:

Medial meniscus root tears comprised 80.0% of the AR group and 77.8% of the O group. The average Kellgren-Lawrence grade was 2 in both groups. The baseline scores for the KOOS Symptoms subscale were lower for AR (50.2 ± 19.3) than for O (66.5 ± 16.1) (P = .003), as were the KOOS Knee-Related Quality of Life scores (AR, 26.7 ± 16.1; O, 39.6 ± 22.1) (P = .046). No differences were found between groups for the absolute values at follow-up except that follow-up Tegner scores were lower in the O group than in the AR group (P = .004). Significant improvements were seen in the AR group from baseline to ultimate follow-up in average KOOS subscale scores (P < .001), Lysholm scores (P < .001), Tegner scores (P = .0002), and VR-12 PCS scores (P < .001), whereas the O group had a significant improvement only in average KOOS Pain (P = .003), KOOS Function in Daily Living (P = .006), and VR-12 PCS (P = .038) scores. Compared with the O group, the AR group had a significantly larger improvement from baseline to follow-up in average KOOS Pain (P = .009), KOOS Symptoms (P = .029), and Lysholm scores (P = .016). During follow-up, 3.3% of the AR group underwent a TKA compared with 33.3% of the O group (P = .008). The hazard ratio of TKA conversion was 93.2% lower for the AR group compared with the O group (P = .013).

Conclusion:

All-inside medial or lateral meniscus root repair showed improved functional outcomes and decreased TKA conversion rates compared with nonoperative treatment and may be considered as a treatment option for the management of meniscus root tears in older patients with moderate osteoarthritis.

中文翻译：

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关节镜全内修复与半月板牙根撕裂老年患者的观察结果。

背景：

弯月面根部撕裂会导致弯月面张紧，接触力增加和软骨损伤。老年有眼泪的患者的治疗存在争议，并且不同治疗方案的疗效尚不清楚。

目的：

为了比较接受全内侧半月板根修复术的中度膝关节骨关节炎患者与内侧或外侧半月板根撕裂的非手术治疗的临床结果。

学习规划：

队列研究；证据水平2。

方法：

接受关节镜修复（AR：30膝）或非手术观察治疗（O：18膝）的确诊为半月板后根撕裂的患者，至少随访2年（平均随访4.4年）。关节镜修复包括全内侧缝合线以减少根回到其残余部分（复位缝合线），从而重新张紧半月板，以及1个褥式缝合线，通过将构造物重新贴近后囊来加强修复。收集的数据包括膝关节损伤和骨关节炎成果评分（KOOS），Lysholm，Tegner和退伍军人RAND 12项健康调查（VR-12）身体成分摘要（PCS）和心理成分摘要（MCS）得分以及转换为总计膝关节置换术（TKA）。

结果：

内侧半月板根部撕裂占AR组的80.0％和O组的77.8％。两组的平均Kellgren-Lawrence成绩均为2。AR的KOOS症状子量表的基线评分（50.2±19.3）低于O的基线评分（66.5±16.1）（P = .003），KOOS膝关节相关的生活质量评分（AR，26.7±16.1; O，39.6±22.1）（P＝ .046）。随访时两组间的绝对值没有差异，只是O组的随访Tegner评分低于AR组（P = .004）。从基线到最终随访，AR组的平均KOOS分量表平均得分（P <.001），Lysholm得分（P <.001），Tegner得分（P = .0002）和VR-12 PCS得分（P <.001），而O组仅在平均KOOS疼痛（P = .003），日常生活中的KOOS功能（P = .006）方面有显着改善。和VR-12 PCS（P = .038）得分。与O组相比，AR组从基线到随访的平均KOOS疼痛（P = .009），KOOS症状（P = .029）和Lysholm评分（P = .016）的改善明显更大。随访期间，AR组接受了TKA的占3.3％，而O组则为33.3％（P = 0.008）。与O组相比，AR组的TKA转化风险比低93.2％（P = .013）。

结论：

与非手术治疗相比，全内侧内侧或外侧半月板根部修复显示出改善的功能结局和降低的TKA转化率，并且可被视为中度骨关节炎老年患者半月板​​根部撕裂的治疗选择。