Background:Despite the clinical benefits over nonoperative treatment or meniscectomy, the clinical outcomes of surgical repair for medial meniscus posterior root tear (MMRT) remain suboptimal, which may be attributed to the insufficient restoration of meniscal hoop tension during surgery.Purpose:To analyze the clinical outcomes of surgical repair of MMRT based on the appearance of the meniscal tension observed immediately after surgery.Study Design:Cohort study; Level of evidence, 3Methods:Electronic medical records of patients who underwent arthroscopic transtibial pull-out repair of MMRT between 2010 and 2021 were retrospectively reviewed. Patients with at least a 2-year follow-up and whose overall meniscal status after the surgical repair could be evaluated via arthroscopic images or videos were eligible to be included. Patients were classified based on the presence of the curtain-cliff sign, potentially implying insufficient postoperative meniscal hoop tension (group 1, patients without the curtain-cliff sign; group 2, patients with the curtain-cliff sign). Regression analysis was performed to evaluate whether the curtain-cliff sign reflects postoperative meniscal extrusion. Subsequently, comparative analyses were conducted between the 2 groups regarding baseline demographic data, clinical scores, intraoperative data, and radiologic parameters.Results:A total of 79 patients were included (group 1, 59 patients; group 2, 20 patients). Regression analysis revealed a significant association between the curtain-cliff sign and postoperative meniscal extrusion, suggesting its potential to reflect the postoperative meniscal tension. In the between-group comparisons, there were no differences in baseline demographic data, preoperative clinical scores, and preoperative radiologic variables. However, at the final follow-up, group 2 showed a significantly lower International Knee Documentation Committee subjective score compared with group 1 (group 1, 61.7 ± 14.4; group 2, 52.9 ± 12.5; P = .017), while no significant differences were found in the visual analog scale for pain score and Lysholm score. Additionally, group 2 exhibited significantly higher postoperative meniscal extrusion compared with group 1, which was measured at both the midpoint of the medial femoral condyle (group 1, 4.0 ± 1.1 mm; group 2, 5.1 ± 1.5 mm, P = .004) and the posterior border of the medial collateral ligament (group 1, 4.4 ± 1.2 mm; group 2, 5.7 ± 1.5 mm; P = .004), with more pronounced progression compared with the preoperative status at these sites. Consistently, the progression of both the osteoarthritis grade and the hip-knee-ankle angle compared with preoperatively was significantly greater in group 2.Conclusion:In patients in whom the restoration of meniscal tension appears insufficient immediately after surgical repair of MMRT, relatively poor clinical outcomes can be anticipated. The findings of this study suggest that efforts to reinforce meniscal tension may be required during surgical repair of MMRT in some cases, especially those showing the curtain-cliff sign.

中文翻译：

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内侧半月板根撕裂手术修复过程中半月板张力恢复不足与手术结局的相关性：Curtain-Cliff 征的临床意义


背景： 尽管临床上优于非手术治疗或半月板切除术，但手术修复内侧半月板后根撕裂 （MMRT） 的临床结局仍然不理想，这可能是由于手术中半月板环张力恢复不足。目的： 根据术后即刻观察到的半月板张力表现，分析 MMRT 手术修复的临床结局。研究设计： 队列研究;证据水平， 3方法： 回顾性回顾 2010 和 2021年接受关节镜下经胫骨拉出修复术 MMRT 的患者的电子病历。随访至少 2 年且手术修复后整体半月板状态可通过关节镜图像或视频评估的患者符合纳入条件。根据 curtain-cliff 征的存在对患者进行分类，可能意味着术后半月板环张力不足 （第 1 组，无 curtain-cliff 征的患者;第 2 组，有 curtain-cliff 征的患者）。进行回归分析以评估 curtain-cliff 征是否反映术后半月板挤压。随后，对 2 组之间的基线人口统计数据、临床评分、术中数据和放射学参数进行比较分析。结果： 共纳入 79 例患者 （第 1 组 59 例;第 2 组 20 例）。回归分析显示，窗帘悬崖征与术后半月板挤压之间存在显著关联，表明其可能反映术后半月板张力。 在组间比较中，基线人口统计数据、术前临床评分和术前放射学变量没有差异。然而，在最终随访中，与第 1 组相比，第 2 组的国际膝关节文献委员会主观评分显着降低（第 1 组，61.7 ± 14.4;第 2 组，52.9 ± 12.5;P = .017），而在疼痛评分和 Lysholm 评分的视觉模拟量表中未发现显着差异。此外，与第 1 组相比，第 2 组术后半月板外拉率显著升高，在股骨内侧髁中点 （第 1 组，4.0 ± 1.1 mm;第 2 组，5.1 ± 1.5 mm，P = .004）和内侧副韧带后缘 （第 1 组，4.4 ± 1.2 mm;第 2 组，5.7 ± 1.5 mm;P = .004），与术前状态相比，这些部位的进展更明显。结论： 在 MMRT 手术修复后半月板张力恢复似乎不足的患者中，可以预期临床结局相对较差。这项研究的结果表明，在某些情况下，在 MMRT 的手术修复过程中可能需要努力加强半月板张力，尤其是那些显示幕布悬崖征的病例。