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Arthroskopische Meniskusrefixierung vs. arthroskopische Meniskusteilresektion

Osteoarthrotische Veränderungen im Mittel- und Langzeitverlauf

Arthroscopic meniscus refixation versus arthroscopic partial meniscus resection

Long and mid-term osteoarthritic changes

  • Leitthema
  • Published:
Arthroskopie Aims and scope

Zusammenfassung

Inwieweit das hinsichtlich operativer Technik und Rehabilitation deutlich aufwendigere Verfahren der arthroskopischen Meniskusrefixierung der arthroskopischen Meniskusteilresektion im mittel- und langfristigen Outcome bzgl. der Osteoarthroseprävention überlegen ist, wird durch diese Studie in einem direkten Vergleich untersucht.

Es wurden 81 Patienten mit isolierter Meniskusverletzung retrospektiv klinisch und radiologisch standardisiert untersucht, 42 Patienten der Meniskusrefixierungsgruppe (MRF) und 39 Patienten der Meniskusteilresektionsgruppe (MTR). Bei der radiologischen Untersuchung wurden beide Kniegelenke entsprechend dem Fairbank-Scoresystem evaluiert. Die Nachuntersuchungszeiträume wurden in ein mittelfristiges Follow-up (3,4 Jahre) und langfristiges Follow-up (8,9 Jahre) unterteilt. Patienten mit beidseitiger Kniegelenkverletzung, fettiger Meniskusdegeneration, Verletzungen des medialen und lateralen Meniskus an einem Knie sowie Achsfehlstellungen wurden von der Untersuchung ausgeschlossen.

Bei einer identischen Erfolgsrate von 95% beider Verfahren zeigen die Langzeitergebnisse nach Meniskusrefixierung 81% im Seitenvergleich entsprechend dem Fairbank-Scoresystem keine Veränderung bzgl. osteoarthrotischer Prozesse. Dagegen sind lediglich 40% nach Meniskusteilresektion bzgl. Verschleißerscheinungen unverändert. Die mittelfristigen Ergebnisse zeigen einen geringen, nicht signifikanten Unterschied zugunsten der Meniskusrefixierungsgruppe.

Die arthroskopische Meniskusrefixierung ermöglicht gegenüber der Meniskusteilresektion bei identischer Komplikationsrate hinsichtlich der Meniskusheilung eine signifikant bessere Therapieoption mit signifikant geringerem Gonarthroserisiko.

Abstract

The mid-term and long-term results of meniscus refixation (MRF) versus the meniscus partial resection (MPR) have not yet been compared directly regarding osteoarthritic changes. A total of 81 patients with an isolated meniscus rupture within a stable knee after arthroscopic meniscus-preserving surgery, were physically and radiologically examined, with 42 patients in the MRF group and 39 in the MPR group. Patients with bilateral knee injuries, previous surgery, additional chondral lesions, strong valgus and/or varus deviation and fatty degenerative meniscus lesions were excluded from the investigation. The osteoarthritic changes were radiologically estimated using the Fairbank score and compared to the other uninjured knee. Retrospectively all patients were reviewed and the time of follow-up was separated into mid-term (3.4 years) and long-term (8.9 years) after arthroscopic meniscus surgery.

The success rate in the long-term follow-up was 95.24% for the MRF group and 94.87% for the MPR group. With respect to osteoarthritic changes, 81% showed no changes after MRF compared to 40% after MPR after 8.9 years. The MRF group showed a slightly lower incidence of osteoarthritic changes for the mid-term results after 3.4 years, but this was not statistically significant.

Arthroscopic MRF for isolated meniscus tears in the vascular zone of the stable knee offers more favourable results regarding induction of osteoarthritis compared to partial meniscus resection with an identical risk of complications.

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  1. Abt. für Sportorthopädie, BG-Unfallklinik Frankfurt am Main, Friedberger Landstraße 430, 60389, Frankfurt am Main, Deutschland

    T. Stein, A. Mehling & A. Jäger

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  3. A. Jäger
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Correspondence to T. Stein.

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Stein, T., Mehling, A. & Jäger, A. Arthroskopische Meniskusrefixierung vs. arthroskopische Meniskusteilresektion. Arthroskopie 21, 239–244 (2008). https://doi.org/10.1007/s00142-008-0503-x

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