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Title: [A prospective randomized control trial of arthroscopic surgery for stable ramp lesion of the medial meniscus].
Author: Liu X, Feng H, Hong L, Zhang H.
Journal: Zhonghua Wai Ke Za Zhi; 2017 Mar 01; 55(3):161-165. PubMed ID: 28241715.
Abstract:
Objective: To evaluate the necessity of arthroscopic suture repair for the stable ramp lesion. Methods: From August 2008 to April 2012, 91 patients of consecutive cases were diagnosed as anterior cruciate ligament (ACL) injury associated with stable ramp lesion in Department of Sports Medicine Service of Beijing Jishuitan Hospital. All of the diagnosis was confirmed during arthroscopic surgeries. The patients were randomized into suture repair group and control group. The ACL was reconstructed using auto grafts of hamstring. MRI was used for evaluation of the healing of the ramp lesion during the follow-up period. The stability of the knee joint was evaluated using KT-1000 device. The clinical functional outcomes were analyzed with Lysholm and International Knee Documentation Committee(IKDC) score. t test and χ(2) test were used to analyze the data, respectively. Results: There were 73 patients (80%) were available for final follow-up. The follow-up period was 24 to 72 months (mean (38.9±16.1) months). The suture repair group included 40 patients, while the control group included 33 patients. There were no statistically difference in age(t=0.458, P>0.05), gender(χ(2)=0.222, P>0.05), time interval from injury(t=0.643, P>0.05) and associated injuries(χ(2)=0.658, P>0.05). At the final follow-up, the healing rate of ramp lesion in suture repair group was 97.5% (95% of complete healed, 2.5% of partial healed, and 2.5% of non-healed), in control group the healing rate was 93.9% (87.8% of complete healed, 6.1% of partial healed, and 6.1% of non healed), there were no significant differences between the two groups (χ(2)=0.446, P>0.05). There was no statistically significant difference of postoperative knee stability (t=-0.510, P>0.05). The healing status of ramp area from MRI evaluation had statistically significant correlation with the ACL stability (χ(2)=11.919, P<0.01). For the analysis of postoperative Lysholm scores and IKDC scores, there was no significant difference between the two groups (t=-0.166, P>0.05; t=0.032, P>0.05). Conclusions: Stable ramp lesion could be well healed after arthroscopic treatment of all-inside suture repair as well as refreshment only. For patients with ACL injury and stable ramp lesion, there was no significant difference between the results of MRI evaluation in the early postoperative stage.The postoperative healing status of ramp area had statistically significant correlation with the stability of knee joint. 目的：探讨稳定型内侧半月板ramp损伤是否需要手术缝合修补。 方法：前瞻性收集2008年8月至2012年4月北京积水潭医院运动医学中心收治的91例经关节镜手术证实为稳定型ramp损伤的患者资料，全部患者接受前交叉韧带(ACL)重建手术(自体腘绳肌腱移植)，术后采用MRI评估ramp损伤愈合状况，采用KT1000测量评估ACL稳定性，主观功能评估采用国际膝关节评分委员会(IKDC)评分及Lysholm膝关节功能评分。计量资料的比较采用t检验，计数资料的比较采用χ(2)检验。 结果： 73例(80%)患者获得随访，随访时间24～72个月，平均(38.9±16.1)个月，缝合组40例，对照组33例。两组患者在年龄(t＝0.458，P>0.05)、性别(χ(2)＝0.222，P>0.05)、受伤至手术时间(t＝0.643，P>0.05)和合并损伤(χ(2)＝0.658，P>0.05)方面差异均无统计学意义。随访时MRI显示缝合组愈合率为97.5%(39/40)，完全愈合率为95.0%(38/40)，部分愈合率与不愈合率均为2.5%(1/40)；对照组愈合率为93.9%(31/33)，完全愈合率为87.8%(29/33)，部分愈合率与不愈合率均为6.1%(2/33)，两组间差异无统计学意义(χ(2)＝0.446，P>0.05)；术后膝关节稳定性差异无统计学意义(t＝－0.510，P>0.05)；ramp损伤完全愈合者其ACL稳定性明显优于部分愈合或不愈合者(χ(2)＝11.919，P<0.01)；两组间术后Lysholm评分和IKDC评分差异均无统计学意义(t＝－0.166，P>0.05；t＝0.032，P>0.05)。 结论：稳定型内侧半月板ramp损伤是否手术缝合与术后早期愈合率及主、客观疗效无关，ramp损伤愈合率与ACL稳定性有显著相关。.

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