Background:Several studies have demonstrated suture repair of ramp lesions of the medial meniscus via a posteromedial approach was associated with a significantly lower rate of secondary meniscectomy. However, these studies are not long-term and highlight the need for extended follow-up research to better understand the outcomes over a more extended period.Purpose:To evaluate the long-term results and reoperation rate for the failure of arthroscopic all-inside suture repair of ramp lesions of the medial meniscus via a posteromedial approach during anterior cruciate ligament (ACL) reconstruction.Study Design:Case series; Level of evidence, 4.Methods:All patients who underwent all-inside suture repair of the posterior segment of the medial meniscus (ramp lesion) via a posteromedial approach during ACL reconstruction at a minimum follow-up of 10 years were included in the study. Side-to-side anterior laxity was assessed preoperatively and postoperatively. Pre- and postoperative functional assessment was based on the subjective International Knee Documentation Committee score for activities of daily living and the Tegner activity scale for sporting ability. Reinterventions for meniscal repair failure and other complications were also recorded at the last follow-up.Results:A total of 81 patients met the inclusion criteria for this study. Two patients had an ACL graft rupture with a new ramp lesion and were excluded from the analysis. Additionally, 15 patients were lost to follow-up, leaving a total of 64 patients in the final analysis. The mean follow-up was 124.8 months (range, 122.4-128.4 months). Mean side-to-side difference in anterior laxity significantly improved from 7.4 ± 1.5 mm (range, 5-12 mm) to 0.4 ± 1.3 mm (range, –3 to 4 mm) ( P = .01). The mean subjective International Knee Documentation Committee score increased from 64.3 ± 13.4 (range, 34-92) before the operation to 91.1 ± 10.1 (range, 49-100) at the last follow-up ( P = .001). The Tegner activity scale score at the last follow-up (6.3 ± 1.6) was lower than that before the trauma (7.1 ± 1.6) ( P = .02). Fourteen patients (21.9%) had a failed meniscal repair and were reoperated. The mean time from initial repair to reoperation was 64.5 months (range, 13-126 months), and the median was 60.6 months. The multivariate analysis, including parameters such as lateral tenodesis (hazard ratio [HR], 1.62; P = .50), preoperative Tegner score (HR, 1.66; P = .41), preoperative laxity (HR, 1.75; P = .35), age at surgery (HR, 1.02; P = .97), and number of sutures (HR, 2.38; P = .19), did not reveal any factors associated with suture failure.Conclusion:The results show that arthroscopic repair of ramp lesions of the medial meniscus during ACL reconstruction using a posteromedial approach has a high failure rate at the 10-year follow-up, with half of these suture failures occurring within 5 years after the initial repair.

中文翻译：

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前交叉韧带重建期间通过后内侧门修复的半月板斜坡病变的生存率和结果：至少 10 年随访的结果研究


背景： 几项研究表明，通过后内侧入路缝合修复内侧半月板的斜坡病变与继发性半月板切除术的发生率显著降低相关。然而，这些研究不是长期的，强调需要扩展随访研究，以更好地了解更长期的结果。目的： 评价前交叉韧带 （ACL） 重建过程中内侧后入路关节镜全内侧缝合修复内侧半月板斜坡病变失败的远期结果和再手术率。研究设计： 病例系列;证据水平，4.方法： 在 ACL 重建期间，所有在至少 10 年随访期间通过后内侧入路对内侧半月板后段 （ramp 病变） 进行全内侧缝合修复的患者均被纳入研究。术前和术后评估侧前松弛度。术前和术后功能评估基于国际膝关节文献委员会日常生活活动主观评分和运动能力 Tegner 活动量表。在最后一次随访中还记录了半月板修复失败和其他并发症的再干预。结果： 共有 81 例患者符合本研究的纳入标准。2 例患者 ACL 移植物断裂伴有新的斜坡病变，被排除在分析之外。此外，15 名患者失访，最终分析共有 64 名患者。平均随访时间为 124.8 个月 （范围，122.4-128.4 个月）。前部松弛度的平均侧侧差异从 7.4 ± 1.5 毫米（范围，5-12 毫米）显着改善± 0.4 1.3 毫米（范围，-3 至 4 毫米）（P = .01）。 平均主观国际膝关节文献委员会评分从手术前的 64.3 ± 13.4 （范围，34-92） 增加到末次随访时的 91.1 ± 10.1 （范围，49-100） （P = .001）。最后一次随访时的 Tegner 活动量表评分 （6.3 ± 1.6） 低于创伤前 （7.1 ± 1.6） （P = .02）。14 例患者 （21.9%） 半月板修复失败并再次手术。从初始修复到再次手术的平均时间为 64.5 个月 （范围，13-126 个月），中位数为 60.6 个月。多变量分析，包括外侧肌腱固定术（风险比 [HR]，1.62;P = .50）、术前 Tegner 评分 （HR，1.66;P = .41）、术前松弛 （HR，1.75;P = .35）、手术年龄 （HR，1.02;P = .97）和缝合数 （HR，2.38;P = .19），未揭示任何与缝合失败相关的因素。结论： 结果显示，使用后内侧入路重建 ACL 时关节镜修复内侧半月板的斜坡病变在 10 年随访中失败率高，其中一半缝合失败发生在初始修复后 5 年内。