Comparison of effect of arthroscopic meniscoplasty and rehabilitation training in the treatment of middle-aged degenerative medial meniscus tear

doi:10.3877/cma.j.issn.1673-9450.2024.02.007

Abstract

Abstract:

Objective

To compare and analyze the clinical effect of arthroscopic meniscoplasty and rehabilitation therapy on middle-aged patients with simple degenerative medial meniscus tear.

Methods

Retrospectively analyzed 90 middle-aged patients with medial meniscus tear admitted to Department of Orthopaedic Surgery in Beijing Tiantan Hospital, Capital Medical University from January 2017 to January 2020. According to the different treatment methods selected by the patients, 48 patients were divided into meniscus repair group and 42 patients were rehabilitated treatment group. The general condition, KOOS, and knee imaging evaluation (KL) were collected before surgery, 3 months and 2 years after surgery, and the clinical effects of the two groups were compared.

Results

There were no differences in age, sex and body mass index between meniscus repair group and rehabilitation treatment group. There was no difference between the preoperative KOOS score (36.61±7.14 VS 36.7±11.59). The KOOS score (64.3±14.39) in the meniscus group was significantly higher than that in the rehabilitation treatment group (44.65±1.66) 3 months after surgery (P<0.05). There was no difference in KOOS score between the meniscus repair group and rehabilitation group (71.2±14.37 VS 72.7±12.15) 2 years after surgery. The progress of knee osteoarthritis was significantly obvious in meniscus repair group(3 cases in KL grade 0, 24 cases in grade 1, 21 cases in grade 2 before surgery; 0 cases in grade 0, 12 cases in grade 1 and 36 cases in grade 2 in 2 years after surgery) than that in the rehabilitation treatment group (4 cases in grade 0, 18 cases in grade 1 and 20 cases in grade 2 before treatment; 0 cases in grade 0, 16 cases in grade 1 and 26 cases in grade 2 in 2 years after treatment).

Conclusion

Compared with rehabilitation treatment, meniscus repair can significantly improve the clinical symptoms and knee function, especially pain and daily living ability in the early stage. There is no significant difference in the mid-term clinical follow-up. Meniscus repair accelerates the progression of knee osteoarthritis. Compared with rehabilitation therapy, arthroscopic meniscus repair has no obvious advantage in the treatment of degenerative medial meniscus tear and should be taken with caution.

Key words: Meniscus tear, Knee arthroscopy, Meniscus repair, Rehabilitation

Weifeng Han, Dian Wang, Yidan Chen, Zheng Zeng. Comparison of effect of arthroscopic meniscoplasty and rehabilitation training in the treatment of middle-aged degenerative medial meniscus tear[J]. Chinese Journal of Injury Repair and Wound Healing(Electronic Edition), 2024, 19(02): 134-140.

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Figures/Tables 4

References 24

[1]	Englund M, Guermazi A, Gale D, et al. Incidental meniscal findings on knee MRI in middle-aged and elderly persons [J]. N Engl J Med, 2008, 359(11): 1108-1115.
[2]	Skou ST, Pihl K, Nissen N, et al. Patient-reported symptoms and changes up to 1 year after meniscal surgery [J]. Acta Orthop, 2018, 89(3): 336-344.
[3]	薛枝秀，寄婧，李月仙，等．医护治一体化工作模式对全膝关节置换术患者生活质量的影响[J]．骨科临床与研究杂志，2022, 7(2): 92-97.
[4]	Kopf S，Beaufils P，Hirschmann MT，et al.Management of traumatic meniscus tears: the 2019 ESSKA meniscus consensus[J]．Knee Surg Sports Traumatol Arthrosc，2020, 28(4): 1177-1194.
[5]	Gauffin H，Tagesson S, Meunier A，et al.Knee arthroscopic surgery is beneficial to middle-aged patients with meniscal symptoms: a prospective, randomised, single-blinded study[J]. Osteoarthritis Cartilage，2014, 22(11)：1808-1816.
[6]	黄野. 有必要更加深入探索保膝手术治疗方法[J]. 骨科临床与研究杂志，2023, 8(6): 325-328.
[7]	Thorlund JB，Juhl CB，Roos EM，et al.Arthroscopic surgery for degenerative knee: systematic review and meta-analysis of benefits and harms[J]．BMJ，2015，49(19)：1229-1235.
[8]	张志昌，茹庆超，杨挺，等. 关节镜下半月板成形术治疗膝关节半月板损伤的临床效果[J]. 临床医学研究与实践，2022, 7(31): 76-78.
[9]	Englund M，Roos EM，Lohmander LS.Impact of type of meniscal tear on radiographic and symptomatic knee osteoarthritis: a sixteen-year followup of meniscectomy with matched controls[J]．Arthritis Rheum，2003, 48(8)：2178-2187.
[10]	Whittaker JL，Losciale JM，Juhl CB，et al.Risk factors for knee osteoarthritis after traumatic knee injury: a systematic review and meta-analysis of randomised controlled trials and cohort studies for the OPTIKNEE Consensus [J]. Br J Sports Med，2022，56(24)：1406-1421.
[11]	Yim JH，Seon JK，Song EK，et al.A comparative study of meniscectomy and nonoperative treatment for degenerative horizontal tears of the medial meniscus[J]．Am J Sports Med，2013，41(7)：1565-1570.
[12]	冷珊珊，刘亚群. 关节镜下半月板成形术联合加速康复外科护理对膝关节半月板损伤患者关节功能与活动度的影响[J]. 现代医学与健康研究(电子版), 2023, 7(15): 119-121.
[13]	Roos EM，Lohmander LS.The knee injury and osteoarthritis outcome score (KOOS): from joint injury to osteoarthritis[J]. Health Qual Life Outcomes, 2003，1：64.
[14]	Tran TDX，Wu CM，Dubey NK，et al.Time-and kellgren^-lawrence grade-dependent changes in intra-articularly transplanted stromal vascular fraction in osteoarthritic patients[J]．Cells，2019，8(4): 308.
[15]	Hwang BY，Kim SJ，Lee SW，et al. Risk factors for medial meniscus posterior root tear [J]．Am J Sports Med, 2012, 40(7): 1606-1610.
[16]	Feucht MJ，Kühle J，Bode G，et al.Arthroscopic transtibial pullout repair for posterior medial meniscus root tears: a systematic review of clinical, radiographic, and second-look arthroscopic results[J]. Arthroscopy，2015，31(9)：1808-1816.
[17]	Wong-Chung D，Schimmel JJP，De Kleuver M, et al.Asymmetrical trunk movement during walking improved to normal range at 3 months after corrective posterior spinal fusion in adolescent idiopathic scoliosis [J]. Eur Spine J，2018，27(2)：388-396.
[18]	Kim SB，Ha JK，Lee SW，et al.Medial meniscus root tear refixation: comparison of clinical, radiologic, and arthroscopic findings with medial meniscectomy[J]．Arthroscopy，2011，27(3): 346-354.
[19]	Lee BS，Bin SI，Kim JM，et al.Partial meniscectomy for degenerative medial meniscal root tears shows favorable outcomes in well-aligned, nonarthritic knees[J]．Am J Sports Med，2019，47(3): 606-611.
[20]	Krych AJ，Johnson NR，Mohan R，et al. Partial meniscectomy provides no benefit for symptomatic degenerative medial meniscus posterior root tears [J]. Knee Surg Sports Traumatol Arthrosc，2018，26(4)：1117-1122.
[21]	Allaire R，Muriuki M，Gilbertson L, et al. Biomechanical consequences of a tear of the posterior root of the medial meniscus. Similar to total meniscectomy[J]．J Bone Joint Surg Am，2008，90(9)：1922-1931.
[22]	Marzo JM，Gurske-Deperio J．Effects of medial meniscus posterior horn avulsion and repair on tibiofemoral contact area and peak contact pressure with clinical implications[J]．Am J Sports Med，2009，37(1)：124-129.
[23]	Kise NJ，Risberg MA，Stensrud S，et al.Exercise therapy versus arthroscopic partial meniscectomy for degenerative meniscal tear in middle aged patients: randomised controlled trial with two year follow-up [J]．BMJ，2016，354：i3740.
[24]	Katz JN，Brophy RH，Chaisson CE，et al.Surgery versus physical therapy for a meniscal tear and osteoarthritis[J]．New Engl J Med，2013，368(18): 1675-1684.

项目	半月板成形组(n＝48)	康复治疗组(n＝42)	F值/ χ²值	P值
年龄(岁，±s)	48.3±6.1	50.1±6.2	1.453	0.937
性别(例)			0.221	0.547
男	18	16
女	30	26
BMI(kg /m²，±s)	26.0±3.6	26.4±4.3	23.768	0.887
KL术前分级(例)			4.766	0.463
0级	3	4
1级	24	18
2级	21	20

项目	半月板成形组(n＝48)	康复治疗组(n＝42)	F值/ χ²值	P值
年龄(岁，±s)	48.3±6.1	50.1±6.2	1.453	0.937
性别(例)			0.221	0.547
男	18	16
女	30	26
BMI(kg /m²，±s)	26.0±3.6	26.4±4.3	23.768	0.887
KL术前分级(例)			4.766	0.463
0级	3	4
1级	24	18
2级	21	20

项目	疼痛	症状	日常生活能力	运动及娱乐能力	膝关节相关生活质量	总分
术前
半月板成形组	10.18±3.57	7.25±1.23	9.3±5.06	4.83±1.03	5.05±6.53	36.61±7.14
康复治疗组	10.35±3.23	6.98±1.73	11.82±4.89	4.13±1.88	3.42±3.54	36.7±11.59
t值	-1.351	1.267	-1.566	1.112	2.134	4.726
P值	0.852	0.515	0.187	0.945	0.059	0.824
术后3个月
半月板成形组	17.24±4.65	8.95±3.54	23.81±11.25	6.85±1.54	7.45±1.75	64.3±14.39
康复治疗组	12.12±2.28	7.45±1.65	13.01±3.88	6.82±1.97	5.25±2.58	44.65±1.66
t值	4.132	2.011	7.546	0.023	3.129-0.196	5.346
P值	0.02^a	0.545	0.01^b	0.854	0.082	0.03^a
术后2年
半月板成形组	18.25±4.99	12.24±2.25	24.62±7.58	8.24±2.63	7.85±1.91	71.2±14.37
康复治疗组	18.33±4.21	13.11±3.81	22.82±8.36	7.77±1.85	10.6±2.11	72.7±12.15
t值	-0.165	-0.865	1.232	2.769	-1.658	-0.196
P值	0.625	0.914	0.862	0.483	0.128	0.774

项目	疼痛	症状	日常生活能力	运动及娱乐能力	膝关节相关生活质量	总分
术前
半月板成形组	10.18±3.57	7.25±1.23	9.3±5.06	4.83±1.03	5.05±6.53	36.61±7.14
康复治疗组	10.35±3.23	6.98±1.73	11.82±4.89	4.13±1.88	3.42±3.54	36.7±11.59
t值	-1.351	1.267	-1.566	1.112	2.134	4.726
P值	0.852	0.515	0.187	0.945	0.059	0.824
术后3个月
半月板成形组	17.24±4.65	8.95±3.54	23.81±11.25	6.85±1.54	7.45±1.75	64.3±14.39
康复治疗组	12.12±2.28	7.45±1.65	13.01±3.88	6.82±1.97	5.25±2.58	44.65±1.66
t值	4.132	2.011	7.546	0.023	3.129-0.196	5.346
P值	0.02^a	0.545	0.01^b	0.854	0.082	0.03^a
术后2年
半月板成形组	18.25±4.99	12.24±2.25	24.62±7.58	8.24±2.63	7.85±1.91	71.2±14.37
康复治疗组	18.33±4.21	13.11±3.81	22.82±8.36	7.77±1.85	10.6±2.11	72.7±12.15
t值	-0.165	-0.865	1.232	2.769	-1.658	-0.196
P值	0.625	0.914	0.862	0.483	0.128	0.774

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