Zusammenfassung
Die Meniskusrefixation in arthroskopischer Technik ist mittlerweile eine Standardprozedur. Neben den klassischen Nahttechniken (inside-out, outside-in) stehen verschiedene intraartikuläre Implantate zur Meniskusnaht zur Verfügung. Die biomechanische Funktion eines refixierten Meniskus scheint der des intakten Meniskus ähnlich zu sein. Die untersuchten Langzeitstudien zeigen, dass die sagittale Stabilität des Gelenks wichtig für die Heilung des genähten Meniskus ist. Die initial besseren Ergebnisse der Meniskusrefixation mit intraartikulären Implantaten relativieren sich im Langzeitverlauf und die Rerupturraten nähern sich jenen nach konventioneller Meniskusnaht an.
Insgesamt benötigt ca. 1/4 der Patienten nach Meniskusrefixation eine Revisionsoperation aufgrund einer Reruptur. Ebenso zeigten sich nur bei etwa 1/4 der Patienten, die eine Meniskusnaht erhalten haben, zweitgradige röntgenologische Arthrosezeichen nach Fairbank im Langzeitverlauf nach bis zu 13 Jahren. Jene Studien, in denen die Arthroserate nach Meniskusnaht mit jener nach Meniskektomie verglichen wurde, liefern Hinweise auf geringere degenerative Veränderungen bei Meniskuserhalt. Die subjektive Zufriedenheit der Patienten nach Meniskusnaht war durchweg hoch. Obwohl prospektive Level-I-Studien zum Langzeitverlauf nach Meniskusrefixation fehlen, ist der klinische Nutzen der Meniskusrefixation unumstritten.
Abstract
The importance of meniscus repair has remarkably increased over the last decades due to developments in arthroscopic surgery. In addition to classical suture techniques, such as inside-out and outside-in, various intra-articular implants for the meniscus suture are also available. It appears that the biomechanical function of a repaired meniscus is similar to that of intact tissue. The reviewed studies with long-term follow-up data show that sagittal joint stability is a key factor for the success of meniscus repair and thus restoration of normal knee function as well as prevention of degenerative articular changes. The initially better results after meniscus refixation with intra-articular implants decreased during follow-up, with rerupture rates comparable to those of conventional suture techniques.
About 25% of patients needed revision surgery for failure of the repair procedure. Only 25% of patients presented radiological signs of second degree degeneration according to Fairbank after up to 13 years follow-up. The studies comparing degenerative changes after meniscus repair with those after meniscectomy indicated that there were less osteoarthritic changes after meniscus repair. The majority of the patients was subjectively satisfied with the results and was assessed as having a normal joint function. With many indicators supporting the importance and benefits of meniscus repair, level I investigations are needed to evaluate its advantages in a scientific way.
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Wilmes, P., Pape, D., Lorbach, O. et al. Klinische Langzeitergebnisse nach Meniskusnaht. Arthroskopie 21, 245–252 (2008). https://doi.org/10.1007/s00142-008-0474-y
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DOI: https://doi.org/10.1007/s00142-008-0474-y