| Objective: Rapid meniscus repair technique is widely used to repair posterior horn medial meniscus(MMPH)tear due to its simple device and easy operation.However,the deep anatomical position of the posterior horn of the medial meniscus makes it difficult for orthopedic surgeons to operate.Based on previous studies and the accumulation of long-term surgical experience,the study added extracutaneous acupuncture technique to the rapid meniscus repair technique to fully open the posterior medial joint space,increase the surgical field and facilitate surgical operation.The torn meniscus is eventually sutured to the posterior joint capsule.The objective of this study was to scientifically evaluate the clinical effect and prognosis of this new technique for the posterior horn of medial meniscus tear repair.Methods: A total of 40 patients,including 15 males and 25 females,were selected from March 2013 to December 2017 in Xinhua Hospital Affiliated to Medical College of Shanghai Jiao Tong University who were treated with rapid meniscus repair combined with acupuncture.The mean age of patients was 59.30±7.89 years(range 45-74years);Body mass index(BMI)was 24.86±3.13 kg/m2.The mean follow-up period was 36 months(range 18-62 months).In this study,the clinical efficacy was comprehensively evaluated from clinical healing rate,anatomical recovery rate,surgical complications and knee function score through comparison of preoperative and postoperative clinical efficacy and literature review with that of other traditional meniscus repair in clinic.Postoperative physical examinations including joint locking,tenderness,joint swelling,and Mc Murray tests were performed using Barrett criteria to assess postoperative clinical healing rate.Patients with negative results on all four of the above physical tests were defined as clinically healed,and those with positive results on any four of the above physical tests we defined as clinically unhealed.Magnetic resonance imaging(MRI)was performed on the patients during postoperative follow-up to evaluate the anatomical recovery rate of the meniscus after surgery,and to assist the postoperative physical examination to carry out a more detailed assessment of the clinical healing rate of the meniscus.All subjects were assessed by a clinician for surgical complications.In addition,the IKDC score,Lysholm score and Tegner activity score were performed pre-and postoperatively to assess the functional status of the knee joint.The higher the score,the better the functional status of the knee joint.In this study,preoperative and postoperative variance analysis were also performed for each knee function score in patients with different preoperative cartilage lesions,as well as the correlation of different preoperative cartilage lesions and age with postoperative knee function scores,so as to further discuss and analyze the comparison of efficacy of this operation with other traditional meniscus repair operations.Results: The clinical symptoms of the patients were significantly improved after surgery.According to Barrett’s criteria,38 patients showed joint locking,tenderness,joint swelling and Mc Murray test were negative,and 2 patients were positive.The clinical healing rate was 95%,and the non-healing rate was 5%.Follow-up MRI showed that 38 patients met the meniscus healing criteria under MRI,consistent with Barrett’s criteria,including 30 patients(75%)with complete healing,8 patients(20%)with partial healing,and 2 patients(5%)with non-healing,and 38 patients(95%)with overall clinical healing;Meniscus anatomical recovery: 28 patients(70%)were completely recovered,10 patients(25%)were partially recovered,2 patients(5%)were not recovered.Overall anatomic recovery rate 95%(38 patients);There were no obvious surgical complications in all patients;In the knee function score,Lysholm score increased from 47.13±23.12 to 87.00±15.00,IKDC score increased from 28.03±20.45 to 70.97±15.33,Tegner score increased from 1.28±1.13 to 3.55±0.68.The three scores were significantly improved after surgery,with statistical differences(P <0.001);ANOVA showed that there was no difference in preoperative Lysholm score,IKDC score and Tegner score among patients with different preoperative cartilage lesions(P values were 0.12,0.48 and 0.67,respectively),and there was a difference in postoperative knee function score(P < 0.05).The correlation study between the two indicated that with the more serious cartilage lesions,The knee function scores of Lysholm,IKDC and Tegner also decreased,with statistical significance(correlation coefficients r were-0.56,-0.70 and-0.50,respectively,with P values less than0.05).Studies on the correlation between age and postoperative knee function scores of Lysholm,IKDC and Tegner showed that knee function scores decreased with the increase of age,with statistical significance(correlation coefficients r were-0.37,-0.33and-0.32,respectively,with P values less than 0.05).Compared with other traditional meniscus repair surgical,this procedure has a higher anatomic recovery rate and clinical healing rate.There were no obvious complications and the complication rate was lower than that of traditional surgical.Knee function scores were lower than those of most conventional surgical.Conclusion: Rapid meniscus repair combined with acupuncture achieved good clinical efficacy in the short and medium follow-up period.The postoperative symptoms of the patients were significantly improved,the clinical meniscus healing rate was as high as95%,the anatomical recovery was good,the postoperative knee joint function was significantly improved,and the incidence of surgical complications was low.It is an effective method for the treatment of posterior horn of medial meniscus tear,which is worth promoting in clinical work in the future. |
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