【整理】膝关节半月板损伤及其治疗

目前在关节组轮转，收了几个半月板损伤的病号，发现不少磁共振有不少的误诊率，其中一个是mri诊断内侧半月板后角损伤，经关节镜探查后诊断为外侧半月板后角损伤；另一个是mri诊断内侧半月板后角损伤，经关节镜探查诊断为外侧半月板破裂，内侧半月板后角损伤。经在园子里搜索发现关于半月板损伤的帖子不少，其中不乏一些精华贴和一些得分贴，现将它们整理出来，为了战友在园子里查资料提高效率，同时自己多做些贡献减轻版主的负担，同时也为自己的第100贴留个纪念意义。

1．半月板MRI解剖特点 来自ljy2006
半月板MRI解剖特点

2．半月板损伤的MRI表现及分期 来自styy
半月板损伤的MRI表现及分期

3．膝关节半月板损伤
膝关节半月板损伤

4．半月板囊肿----病例讨论 来自tzyygkwb
半月板囊肿----病例讨论

5．膝关节半月板MRI的新进展 来自ljs123456789
膝关节半月板MRI的新进展

6．正常半月板与损伤半月板的超声图对比 来自：紫风玲声
正常半月板与损伤半月板的超声图对比

7．半月板损伤，MRI的价值到底有多少？[精华] 来自：webal
半月板损伤，MRI的价值到底有多少？

8．半月板破裂关节镜下手术 来自shilaoda
半月板破裂关节镜下手术

9．关于关节镜的一些资料 来自Frankgaodi
关于关节镜的一些资料

10．半月板缝合术后康复训练 来自wangzi858621
半月板缝合术后康复训练

11．半月板的生物力学及其损伤修复的研究进展zsh19810809
半月板的生物力学及其损伤修复的研究进展

12．The meniscal roots: gross anatomic correlation with 3-T MRI findings.
AJR Am J Roentgenol. 2007 May;188(5):W446-50
•  Brody JM, Hulstyn MJ, Fleming BC, Tung GA.
Department of Diagnostic Imaging, Brown Medical School, Rhode Island Hospital, 593 Eddy St., Providence, RI 02903, USA. jbrody@lifespan.org
OBJECTIVE: The purpose of this article is to highlight the normal anatomic features of the meniscal roots on photographs of dissected cadaveric knee specimens and 3-T MR images. CONCLUSION: The meniscal roots, which are critical attachment sites of the medial and lateral menisci to the central tibial plateau, are well-visualized on intermediate-weighted, turbo spin-echo 3-T MRI and can be identified in proximity to the tibial insertions of the anterior and posterior cruciate ligaments.
PMID: 17449741 [PubMed - indexed for MEDLINE]
The meniscal roots: gross anatomic correlation with 3-T MRI findings

13.Meniscal sizing based on gender, height, and weight.
Arthroscopy. 2007 May;23(5):503-8.
•  Stone KR, Freyer A, Turek T, Walgenbach AW, Wadhwa S, Crues J.
Stone Research Foundation, San Francisco, California 94123, USA. kstonemd@stoneclinic.com
PURPOSE: Successful meniscus transplantation may depend on accurate sizing. Meniscal sizing is currently determined by measuring a combination of bony landmarks and soft-tissue insertion points through images obtained radiographically or by magnetic resonance imaging (MRI). The literature widely reports inaccuracy in sizing resulting from radiographic errors in magnification, erroneous identification of bony landmarks, and difficulty in differentiating between the soft-tissue and bone interface. In our meniscus transplantations we have observed that when the height and weight of the recipient matched those of the donor, the meniscal size appeared to be a match at surgical implantation; we designed this study to confirm this observation. METHODS: The MRI-based meniscal sizing of 111 patients (63 male and 38 female patients; mean age, 44 years [range, 15 to 76 years]), totaling 147 menisci (87 lateral and 60 medial), was compared with the height, weight, gender, and body mass index (BMI) of each patient. MRI scans were obtained with a 1.0-Tesla MRI system (ONI Medical Systems, Wilmington, MA). Sizing was performed by an independent musculoskeletal MRI radiologist as established by the literature. Statistical methods include nonparametric Pearson correlation (r) between MRI-based lateral meniscal width, lateral meniscal length, medial meniscal width, medial meniscal length, total tibial plateau width, and patient height, weight, gender, and BMI. Significance at the P = .05 level was used. RESULTS: Height was found to have a linear relationship to total tibial plateau, which has a good predictive correlation with meniscal dimensions of r > 0.7. Female patients generally present with smaller dimensions than male patients. High-BMI groups present with significantly larger meniscal dimensions than low-BMI groups at any given height. CONCLUSIONS: Height, weight, and gender are easily obtained variables and are proportional to meniscal tissue dimensions. These exploratory statistics establish correlations between height, weight, gender, total tibial plateau width, and meniscal size. CLINICAL RELEVANCE: Height, weight, and gender should be considered by both tissue banks and surgeons as fast and cost-effective variables by which to predict meniscal dimensions.
PMID: 17478281 [PubMed - in process]
Meniscal sizing based on gender, height, and weight

14.MR diagnosis of meniscal tears of the knee: analysis of error patterns.
Arch Orthop Trauma Surg. 2007 Apr 14; [Epub ahead of print]
•  Van Dyck P, Gielen J, D'Anvers J, Vanhoenacker F, Dossche L, Van Gestel J, Parizel PM.
Department of Radiology, University Hospital Antwerp, Edegem, Belgium.
PURPOSE: Despite high accuracy of magnetic resonance imaging (MRI) for diagnosing meniscal tears, MR findings do not always agree with surgical findings. We performed a blinded, retrospective study to analyze the nature and frequency of errors in the MR diagnosis of meniscal tears. MATERIALS AND METHODS: Medical records of 100 consecutive patients who underwent MR and arthroscopy of the knee at our institution were reviewed. Twelve patients underwent prior meniscal surgery. Twenty-three patients had 27 discrepancies between MR and surgical findings. These were independently reviewed by two additional musculoskeletal radiologists in a double blinded fashion. Original incorrect diagnoses were categorized as either unavoidable, interpretation error or equivocal for meniscal tear. RESULTS: MR accuracy was 88% for the medial and 85% for the lateral meniscus. Of 27 incorrect MR diagnoses, 12 (44%) were unavoidable, 10 (37%) equivocal and 5 (19%) interpretation errors. Of the 67 medial meniscal tears, 12 (18%) were missed. Eight (67%) of these 12 were categorized as equivocal, including three postoperative menisci. Of 30 lateral tears, 12 (40%) were missed, 7 (58%) of which were categorized as unavoidable. Of these 12, 11 (92%) showed fraying of the inner edge, which was shaved at arthroscopy (n = 8) or had stable tear treated conservatively (n = 3). There were three false-positive diagnoses, all occuring in the lateral meniscus, two of which were unavoidable and one interpretation error. CONCLUSION: Of all missed lateral meniscal tears, most are unavoidable and related to confusion between what represents fraying and what represents a tear. Unavoidable false-positive diagnoses are infrequent and may be related to incomplete arthroscopic evaluation. Subtle or equivocal findings still make MR diagnosis difficult, even for experienced radiologists.
PMID: 17440743 [PubMed - as supplied by publisher]
MR diagnosis of meniscal tears of the knee: analysis of error patterns

15.Meniscus allograft transplantation: ten-year results of cryopreserved allografts.
Arthroscopy. 2007 Apr;23(4):388-93
•  Hommen JP, Applegate GR, Del Pizzo W.
Orthopaedic Institute at Mercy Hospital, Miami, Florida 33133, USA. jphommen@hotmail.com
PURPOSE: We report the results of cryopreserved meniscus allograft transplantations with 10 or more years of follow-up. METHODS: Fourteen medial and 8 lateral meniscus allografts were evaluated with a mean follow-up of 141 months (range, 115 to 167 months). The clinical outcome and failure rate was evaluated by use of a Lysholm score and modified pain score in 22 patients. The results of radiographic and magnetic resonance imaging (MRI) analysis were reported in 15 and 7 patients, respectively. RESULTS: Overall, 25% of medial allografts and 50% of lateral allografts failed. The combined failure rate was 35%. There was a 90% improvement in Lysholm scores, as well as pain scores. There were no discernible Lysholm or pain score differences for both lateral and medial allografts. Furthermore, there was no discernible difference in both Lysholm and pain scores between bone plug and soft-tissue methods of graft fixation. Ten of fifteen allografts showed radiographic joint space narrowing, and twelve had progression of degenerative joint disease. On MRI, all grafts had moderate meniscus shrinkage and five had grade III signal intensities. Eighty-five percent of patients underwent subsequent procedures, 5 of whom required total allograft resection and 2 of whom required partial allograft resection. One allograft required repair. CONCLUSIONS: Although transplantation of cryopreserved allografts improved knee pain and function, the average knee function was fair at long-term follow-up. Fifty-five percent of allografts failed when failure criteria for second-look surgery, knee improvement surveys, and MRI were added to Lysholm and pain score failures. The protective benefits of meniscus allografts remain debatable, and inferences cannot be made from this study. LEVEL OF EVIDENCE: Level IV, therapeutic case series.
PMID: 17418331 [PubMed - indexed for MEDLINE]
Meniscus allograft transplantation: ten-year results of cryopreserved allografts

16.Torn discoid lateral meniscus treated with arthroscopic meniscectomy: observations in 62 knees.
Chin Med J (Engl). 2007 Feb 5;120(3):211-5.
•  Lu Y, Li Q, Hao J.
Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China. guluying@yahoo.com.cn
BACKGROUND: Discoid lateral meniscus of the knee is common in Chinese population. There has been considerable debate about the best treatment for discoid lateral meniscus tears. The purpose of this study was to observe the effect of arthroscopic meniscectomy for the treatment of discoid lateral meniscus tears. METHODS: Between July 1999 and December 2004, arthroscopic meniscectomy was performed on 62 menisci of 57 patients with discoid lateral meniscus tears (52 unilateral, 5 bilateral). 41 menisci were "complete discoid meniscus", 21 "incomplete". According to the extent of the meniscus tears, partial meniscectomy was performed on 52 knees, total meniscectomy on 7 knees, and partial meniscectomy combined with meniscus suture on 3 knees through an arthroscope. After the operations, early rehabilitation training programs, including straight-leg-raising and range-of-motion exercises, were carried out. 51 patients were followed up for 1 year 2 months to 6 years 5 months (mean, 3 years 3 months), 6 patients were lost. Lysholm-II scoring system was used to assess the function of the knee joints before the operation and during the follow-up. RESULTS: The operations on all the 62 knees were successful without complications. The patients could walk normally after completing the 2-week postoperation rehabilitation program. After 3 - 4 weeks they could lead a normal life and participate in a moderate amount of sports or other physical activities. The mean Lysholm-II score was 89 (60 - 100) during the follow-up, which was significantly higher than that before the operation (50, range 34 - 74; P < 0.01). 88% of the patients achieved excellent or good clinical results. CONCLUSIONS: Arthroscopic meniscectomy is an alternative for treatment of discoid lateral meniscus tears with minimal traumatic effects. It can achieve early mobilization and a low complication rate, as well as the preservation of the meniscus structure and functions to the largest extent. In combination with proper rehabilitation training, the operation can lead to good or excellent results.
PMID: 17355823 [PubMed - indexed for MEDLINE]
Torn discoid lateral meniscus treated with arthroscopic meniscectomy: observations in 62 knees.

17.Development and clinical application of meniscal unicompartmental arthroplasty.
Proc Inst Mech Eng [H]. 2007 Jan;221(1):47-59.
•  O'Connor JJ, Goodfellow JW, Dodd CA, Murray DW.
Department of Engineering Science and Oxford Orthopaedic Engineering Centre, University of Oxford, Oxford, UK. johnoconnor333@btconnect.com
About one-third of osteoarthritic patients requiring knee replacement have focal lesions limited mainly to the medial compartment and can achieve excellent postoperative function after medial unicompartmental replacement. However, late failures of many unicompartmental prostheses require revision at a rate about twice that of total knee replacement. The use of a fully conforming mobile-bearing meniscal unicompartmental prosthesis in the hands of experienced surgeons can reduce revision rates to levels equivalent to the best results achieved with total knee replacement. The paper argues the case for such a prosthesis and demonstrates that the usual modes of failure of unicompartmental arthroplasty, most of them biomechanical, can thereby be avoided.
PMID: 17315768 [PubMed - indexed for MEDLINE]
Development and clinical application of meniscal unicompartmental arthroplasty

希望战友跟帖回复，完善半月板方面的资料