EFFECTIVENESS OF ARTHROSCOPIC TREATMENT FOR COMBINED INJURY OF POSTERIOR HORN OF MEDIAL MENISCUS AND ANTERIOR HORN OF LATERAL MENISCUS_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 CHENZhiwei , WUJunxing , LIANGXianyong , SHENGZhen

Department of Orthopedics, First Affiliated Hospital, University of South China, Hengyang Hunan, 421001, P. R. China;

Corresponding author：

CHENZhiwei, Email: czw9915@sina.com

Keywords：

Meniscal injury; Medial meniscus; Lateral meniscus; Arthroscope

DOI：

10.7507/1002-1892.20140100

Video：

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Objective To investigate the effectiveness of arthroscopic treatment for combined injury of the posterior horn of the medial meniscus (PHMM) and the anterior horn of the lateral meniscus (AHLM). Methods Between September 2009 and December 2012, 36 patients (36 knees) with combined injury of PHMM and AHLM underwent arthroscope surgery. There were 16 males and 20 females with an average age of 47 years (range, 30-64 years), and a median disease duration of 30 months (range, 3 months-9 years). The left knee was involved in 14 cases and the right knee in 22 cases. Two patients had a history of sprain, and other patients had no obvious incentive. The patients had limited activity of the knee in varying degrees; posterior medial tenderness in the medial knee joint space and positive Mcmurray tests were found in all cases, and anterior tenderness in the lateral knee joint space in 26 cases. Effusion of the knee joint occurred in 5 cases. The X-ray and MRI before operation indicated injury of PHMM combined with injury of AHLM in 30 cases and simple injury of PHMM in 6 cases; meniscal cyst was found in 2 cases, and popliteal cyst in 1 case. Partial meniscectomy was used for PHMM, the external-inner suture or partial meniscectomy was used for AHLM. Results All incisions healed primarily with no complication. All cases were followed up 22.5 months on average (range, 10-40 months). At last follow-up, the patients had no pain, weakness, and instability, and tenderness in medial and lateral joint space disappeared. Except 4 patients who had weakly positive Mcmurray test, the results of Mcmurray test were negative in the others. Based on the improved Lysholm classification standard, the results were excellent in 25 cases, good in 8 cases, and fair in 3 cases; the excellent and good rate was 91.7%. Conclusion Arthroscopic primary repair of combined injury of PHMM and AHLM can effectively recover the knee function with a better effectiveness.

Citation： CHENZhiwei, WUJunxing, LIANGXianyong, SHENGZhen. EFFECTIVENESS OF ARTHROSCOPIC TREATMENT FOR COMBINED INJURY OF POSTERIOR HORN OF MEDIAL MENISCUS AND ANTERIOR HORN OF LATERAL MENISCUS. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(4): 438-441. doi: 10.7507/1002-1892.20140100 Copy

1.	余家阔, 于长隆, 敖英芳, 等. 膝关节半月板损伤的手术修复疗效观察. 中华创伤骨科杂志, 2006, 8(6):524-528.
2.	Cameron JC, Saha S. Meniscal allograft transplantation for unicompartmental arthritis of the knee. Clin Orthop Relat Res, 1997, (337):164-171.
3.	Almedghio SM, Shablahidis O, Rennie W, et al. Wii knee revisited:meniscal injury from 10-pin bowling. BMJ Case Reports, 2009, 7(3):1242-1243.
4.	Nagura T, Dyrby CO, Alexander EJ, et al. Mechanical loads at the knee joint during deep flexion. J Orthop Res, 2002, 20(4):881-886.
5.	Tanavalee A, Ngarmukos S, Tantavisut S, et al. High-flexion TKA in patients with a minimum of 120 degrees of pre-operative knee flexion:outcomes at six years of follow up. Int Orthop, 2011, 35(9):1321-1326.
6.	Acker SM, Cockburn RA, Krevolin J, et al. Knee kinematics of high-flexion activities of daily living performed by male Muslims in the Middle East. J Arthroplasty, 2011, 26(2):319-327.
7.	Hemmerich A, Brown H, Smith S, et al. Hip, knee, and ankle kinematics of high range of motion activities of daily living. J Orthop Res, 2006, 24(4):770-781.
8.	Zhang Y, Hunter DJ, Nevitt MC, et al. Association of squatting with increased prevalence of radiographic tibiofemoral knee osteoarthritis:the Beijing Osteoarthritis Study. Arthritis Rheum, 2004, 50(4):1187-1192.
9.	黄荣瑛, 郭云飞, 徐强, 等. 半月板切除对多屈曲角位姿胫股关节接触性能的影响. 工程力学, 2012, 29(9):300-307.
10.	Allaire RR, Muriuki M, Gilbertson L, et al. Biomechanical consequences of a tear of the posterior root of the medial meniscus. Similar to total meniscectomy. J Bone Joint Surg (Am), 2008, 90(9):1922-1931.
11.	王骏飞, 蒋青, 陈东阳, 等. 半月板切除对下肢力线的影响. 中华骨科杂志, 2005, 25(8):481-484.
12.	Peña E, Calvo B, Martinez MA, et al. Finite element analysis of the effect of the meniscal tears and meniscectomies on human knee biomechanics. Clin Biomench (Bristol, Avon), 2005, 20(5):498-507.
13.	解新刚, 姜雪锋, 张云庆, 等. 膝关节内侧半月板体部及后角应力变化的生物力学. 江苏医药, 2010, 36(16):1945-1946.
14.	Behairy NH, Dorgham MA, Khaled SA. Accuracy of routine magnetic resonance imaging in meniscal and ligamentous injuries of the knee:comparison with arthroscopy. Int Orthop, 2009, 33(4):961-967.
15.	龙浩, 董伟强, 白波, 等. MRI检查对半月板损伤类型的评价. 中国组织工程研究与临床康复, 2010, 14(17):3081-3084.
16.	Choi NH, Victoroff BN. Anterior horn tears of the lateral meniscus in soccer players. Arthroscopy, 2006, 22(5):484-488.
17.	Shepard MF, Hunter DM, Davies MR, et al. The clinical significance of anterior horn meniscal tears diagnosed on magnetic resonance images. Am J Sports Med, 2002, 30(2):189-192.
18.	De Smet AA, Mukherjee R. Clinical, MRI, and arthroscopic findings associated with failure to diagnose a lateral meniscal tear on knee MRI. AJR Am J Roentgenol, 2008, 190(1):22-26.
19.	Oei EH, Nikken JJ, Verstijnen AC. MR imaging of the menisci and cruciate ligaments:a systematic review. Radiology, 2003, 226(3):837-848.
20.	Petersen W, Zantop T. Arthroscopic meniscal suture. Oper Orthop Traumatol, 2006, 18(5-6):393-410.

1. 余家阔, 于长隆, 敖英芳, 等. 膝关节半月板损伤的手术修复疗效观察. 中华创伤骨科杂志, 2006, 8(6):524-528.
2. Cameron JC, Saha S. Meniscal allograft transplantation for unicompartmental arthritis of the knee. Clin Orthop Relat Res, 1997, (337):164-171.
3. Almedghio SM, Shablahidis O, Rennie W, et al. Wii knee revisited:meniscal injury from 10-pin bowling. BMJ Case Reports, 2009, 7(3):1242-1243.
4. Nagura T, Dyrby CO, Alexander EJ, et al. Mechanical loads at the knee joint during deep flexion. J Orthop Res, 2002, 20(4):881-886.
5. Tanavalee A, Ngarmukos S, Tantavisut S, et al. High-flexion TKA in patients with a minimum of 120 degrees of pre-operative knee flexion:outcomes at six years of follow up. Int Orthop, 2011, 35(9):1321-1326.
6. Acker SM, Cockburn RA, Krevolin J, et al. Knee kinematics of high-flexion activities of daily living performed by male Muslims in the Middle East. J Arthroplasty, 2011, 26(2):319-327.
7. Hemmerich A, Brown H, Smith S, et al. Hip, knee, and ankle kinematics of high range of motion activities of daily living. J Orthop Res, 2006, 24(4):770-781.
8. Zhang Y, Hunter DJ, Nevitt MC, et al. Association of squatting with increased prevalence of radiographic tibiofemoral knee osteoarthritis:the Beijing Osteoarthritis Study. Arthritis Rheum, 2004, 50(4):1187-1192.
9. 黄荣瑛, 郭云飞, 徐强, 等. 半月板切除对多屈曲角位姿胫股关节接触性能的影响. 工程力学, 2012, 29(9):300-307.
10. Allaire RR, Muriuki M, Gilbertson L, et al. Biomechanical consequences of a tear of the posterior root of the medial meniscus. Similar to total meniscectomy. J Bone Joint Surg (Am), 2008, 90(9):1922-1931.
11. 王骏飞, 蒋青, 陈东阳, 等. 半月板切除对下肢力线的影响. 中华骨科杂志, 2005, 25(8):481-484.
12. Peña E, Calvo B, Martinez MA, et al. Finite element analysis of the effect of the meniscal tears and meniscectomies on human knee biomechanics. Clin Biomench (Bristol, Avon), 2005, 20(5):498-507.
13. 解新刚, 姜雪锋, 张云庆, 等. 膝关节内侧半月板体部及后角应力变化的生物力学. 江苏医药, 2010, 36(16):1945-1946.
14. Behairy NH, Dorgham MA, Khaled SA. Accuracy of routine magnetic resonance imaging in meniscal and ligamentous injuries of the knee:comparison with arthroscopy. Int Orthop, 2009, 33(4):961-967.
15. 龙浩, 董伟强, 白波, 等. MRI检查对半月板损伤类型的评价. 中国组织工程研究与临床康复, 2010, 14(17):3081-3084.
16. Choi NH, Victoroff BN. Anterior horn tears of the lateral meniscus in soccer players. Arthroscopy, 2006, 22(5):484-488.
17. Shepard MF, Hunter DM, Davies MR, et al. The clinical significance of anterior horn meniscal tears diagnosed on magnetic resonance images. Am J Sports Med, 2002, 30(2):189-192.
18. De Smet AA, Mukherjee R. Clinical, MRI, and arthroscopic findings associated with failure to diagnose a lateral meniscal tear on knee MRI. AJR Am J Roentgenol, 2008, 190(1):22-26.
19. Oei EH, Nikken JJ, Verstijnen AC. MR imaging of the menisci and cruciate ligaments:a systematic review. Radiology, 2003, 226(3):837-848.
20. Petersen W, Zantop T. Arthroscopic meniscal suture. Oper Orthop Traumatol, 2006, 18(5-6):393-410.

Chinese Journal of Reparative and Reconstructive Surgery

EFFECTIVENESS OF ARTHROSCOPIC TREATMENT FOR COMBINED INJURY OF POSTERIOR HORN OF MEDIAL MENISCUS AND ANTERIOR HORN OF LATERAL MENISCUS

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