Background:

Representing approximately 10% of all meniscal tears, bucket-handle meniscal tears (BHMTs) are large longitudinal vertical tears that have an attached fragment flipped into the intercondylar notch. Meniscectomy often results in significant meniscal loss and increased joint loading. Alternatively, meniscal repair attempts to restore the function of the meniscus and aims to preserve joint mechanics.

Purpose:

To evaluate the long-term risk of subsequent ipsilateral knee surgery in patients who underwent a bucket-handle meniscal repair (BHMR), and to assess risk factors associated with subsequent knee surgical intervention.

Study Design:

Case series; Level of evidence, 4.

Methods:

We performed an electronic health record search for all patients aged 12 to 65 years who underwent arthroscopic knee meniscal repairs for BHMT (2011-2018). We excluded patients who had a previous BHMR, did not have magnetic resonance imaging of the knee within 60 days before BHMR, lacked active membership in Kaiser insurance in the year before and after BHMR, or underwent meniscectomy before BHMR. All patients were followed until December 31, 2019, with censoring at death or membership disenrollment. Primary outcomes included ipsilateral knee procedures overall and by type (ie, repeat meniscal repair and meniscectomy); secondary outcomes included other surgical interventions of the same knee, any contralateral knee surgery, deep surgical-site infection, and deep venous thrombosis or pulmonary embolism.

Results:

The final cohort included 1359 patients with a median age of 24 years (interquartile range [IQR], 17-34) who underwent BHMR for a BHMT. During the follow-up period (median, 50.2 months [IQR, 32.3-60.6]), 495 subsequent ipsilateral procedures were performed in 274 (20.2%) patients, and the median time to the first procedure was 10.6 months (IQR, 4.1-23.5). An overall 59 (4.3%) patients underwent repeat meniscal repair, and 165 (12.1%) had a subsequent meniscectomy of the same knee. Significant risk factors for subsequent ipsilateral procedures included younger age, 12 to 18 years (adjusted odds ratio [aOR], 5.77 [95% CI, 1.84-18.08]) and 19 to 30 years (aOR, 3.65 [95% CI, 1.17-11.36]), as well as normal and overweight body mass index (aOR, 2.84 [95% CI, 1.29-6.23] and 2.34 [95% CI, 1.06-5.17], respectively). Patients undergoing concomitant anterior cruciate ligament reconstruction (ACLR) at the initial BHMR had a lower risk of undergoing subsequent surgery (aOR, 0.66 [95% CI, 0.49-0.87]) than those without concomitant ACLR.

Conclusion:

This is the largest reported study on outcomes after BHMR in a contained cohort. One-fifth of patients underwent subsequent ipsilateral surgery during follow-up, with 4.3% receiving a repeat meniscal repair and 12.1% experiencing a meniscectomy. Risk factors for subsequent surgery of the same knee included younger age and normal or overweight body mass index. Concomitant ACLR at time of BHMR reduced the risk of subsequent reoperation.

中文翻译：

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桶柄半月板修复后的手术结果：大型包含队列的分析

背景：

桶柄半月板撕裂 (BHMT) 约占所有半月板撕裂的 10%，是大型纵向垂直撕裂，其附着的碎片翻转到髁间切迹中。半月板切除术通常会导致明显的半月板丢失和关节负荷增加。或者，半月板修复试图恢复半月板的功能并旨在保持关节力学。

目的：

评估接受桶柄半月板修复 (BHMR) 的患者后续同侧膝关节手术的长期风险，并评估与后续膝关节手术干预相关的风险因素。

学习规划：

案例系列；证据水平，4。

方法：

我们对所有接受 BHMT 关节镜膝关节半月板修复的 12 至 65 岁患者（2011-2018 年）进行了电子健康记录搜索。我们排除了既往有 BHMR、在 BHMR 之前 60 天内没有进行膝关节磁共振成像、在 BHMR 之前和之后一年内没有积极加入 Kaiser 保险或在 BHMR 之前接受过半月板切除术的患者。对所有患者进行随访至 2019 年 12 月 31 日，并在死亡或会员退出时进行审查。主要结果包括整体同侧膝关节手术和按类型（即重复半月板修复和半月板切除术）；次要结局包括同一膝关节的其他手术干预、任何对侧膝关节手术、深部手术部位感染以及深静脉血栓形成或肺栓塞。

结果：

最后一个队列包括 1359 名中位年龄为 24 岁（四分位距 [IQR]，17-34）的患者，他们接受了 BHMR 以进行 BHMT。在随访期间（中位数，50.2 个月 [IQR，32.3-60.6]），274 名（20.2%）患者进行了 495 次随后的同侧手术，到第一次手术的中位时间为 10.6 个月（IQR，4.1- 23.5)。共有 59 名 (4.3%) 患者接受了重复半月板修复，165 名 (12.1%) 患者随后对同一膝关节进行了半月板切除术。随后同侧手术的重要危险因素包括年龄较小，12 至 18 岁（调整优势比 [aOR]，5.77 [95% CI，1.84-18.08]）和 19 至 30 岁（aOR，3.65 [95% CI，1.17- 11.36]），以及正常和超重的体重指数（aOR, 2.84 [95% CI, 1.29-6.23] 和 2.34 [95% CI, 1.06-5.17]）。

结论：

这是在包含的队列中关于 BHMR 后结果的最大报告研究。五分之一的患者在随访期间接受了随后的同侧手术，其中 4.3% 接受了重复半月板修复，12.1% 接受了半月板切除术。同一膝关节后续手术的危险因素包括年龄较小和体重指数正常或超重。BHMR 时伴随的 ACLR 降低了随后再次手术的风险。