Meniscal Comma Sign Responds to Partial Meniscectomy Despite Increased Levels of Arthritis

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Abstract

Purpose

To compare the outcomes of patients undergoing partial meniscectomy preoperatively identified with the “meniscal comma sign” with those undergoing meniscectomy with other tear patterns.

Methods

Patients with meniscal “comma sign,” as indicated by a query of magnetic resonance imaging reports, were screened using the search terms “meniscotibial recess,” “meniscus perched over the medial tibial margin,” or other search terms by radiologists between January 2008 and November 2019. Patients were matched and chart review was done for demographics, revision surgery, and progression to total knee arthroplasty. Radiographs were used for osteoarthritis grading using the Kellgren-Lawrence (KL) scoring system. Preoperative and postoperative International Knee Documentation Committee, Knee Injury and Osteoarthritis Outcome Score, Lysholm, and Short Form 12-item Survey scores were collected.

Results

A total of 406 patients met inclusion (comma sign = 197; control group = 209). The control group had an increased duration of symptoms at the initial visit (P = .001). More patients with the meniscal comma sign received corticosteroid knee injections before surgery (P = .011), and they also had greater mean KL scores (P = .001) as well as greater KL categorical scores (P = .002), indicating more advanced levels or arthritis. There were no differences in those receiving physical therapy (PT) before surgery (P = .966) or those receiving injections or PT after surgery (P = .631, P = .37, respectively). International Knee Documentation Committee, Knee Injury and Osteoarthritis Outcome Score, Lysholm, and Short Form 12-Item Survey Physical scores improved preoperatively to postoperatively in both groups (P < .05), and there was no difference between the case and control group (P > .05). No significant difference was found in revisions or progression to total knee arthroplasty between cohorts. (P = .676 and P = .424).

Conclusions

Patients presenting with preoperative findings of meniscal comma sign fare similarly to those that do not. Patients with this meniscal injury tend to have more advanced grading of osteoarthritic changes in the knee at presentation and seek care earlier than those without. Arthroscopic meniscectomy is a good treatment option for patients with a meniscal fragment in the meniscotibial recess and shows outcomes comparable with those with other tear patterns.

Level of Evidence

Level III, retrospective cohort.

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尽管关节炎程度增加,半月板逗号标志对半月板部分切除术仍有反应。
目的 比较术前发现有 "半月板逗号征 "的半月板部分切除术患者与有其他撕裂形态的半月板切除术患者的治疗效果。方法 2008年1月至2019年11月期间,放射科医生使用 "半月板胫骨凹陷"、"半月板栖息于胫骨内侧缘 "或其他检索词,通过磁共振成像报告查询筛选出有半月板 "逗号征 "的患者。对患者进行配对,并查阅病历以了解患者的人口统计学特征、翻修手术和全膝关节置换术的进展情况。采用凯尔格伦-劳伦斯(Kellgren-Lawrence,KL)评分系统对X光片进行骨关节炎分级。此外,还收集了术前和术后国际膝关节文献委员会、膝关节损伤和骨关节炎结果评分、Lysholm 和简表 12 项调查评分。对照组初次就诊时症状持续时间更长(P = .001)。更多半月板逗号征患者在手术前接受了皮质类固醇膝关节注射(P = .011),他们的平均 KL 评分更高(P = .001),KL 分类评分更高(P = .002),表明关节炎的程度更严重。手术前接受物理治疗(PT)者(P = .966)和手术后接受注射或物理治疗者(P = .631,P = .37)之间没有差异。两组患者的国际膝关节文献委员会、膝关节损伤和骨关节炎结果评分、Lysholm 和简表 12 项调查物理评分从术前提高到术后(P < .05),病例组和对照组之间没有差异(P > .05)。两组患者在翻修或发展为全膝关节置换术方面无明显差异。(结论术前发现半月板逗号征的患者与未发现半月板逗号征的患者情况相似。有这种半月板损伤的患者往往在就诊时膝关节骨关节炎病变的分级较高,就诊时间也早于没有半月板损伤的患者。关节镜下半月板切除术对于半月板胫骨凹陷处有半月板碎片的患者是一种很好的治疗选择,其疗效与其他撕裂模式的患者相当。
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来源期刊
CiteScore
2.70
自引率
0.00%
发文量
218
审稿时长
45 weeks
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