Evaluation Of The Curative Effect Of Partial Meniscectomy In The Treatment Of Degenerative MMPRT And Analysis Of The Reasons For The Progression Of Postoperative Medial Arthritis

Part1 Evaluation of the Curative Effect of Partial Meniscectomy in the Treatment of Degenerative MMPRTObjective:The purpose of this study is to evaluate the curative effect of partial meniscectomy for degenerative medial meniscus posterior root tears.Whether partial meniscectomy is sufficient to produce good clinical results,so as to provide reference for the choice of surgical plan for patients.Methods:A total of 195 patients with degenerative medial meniscus posterior root tears treated by partial meniscectomy in our hospital from January 2012 to December 2014 were analyzed retrospectively,of which 7 lost follow-up.So 188 patients were analyze,the average follow-up was 7.17 ±1.37(mean ± standard deviation)years.All operations were performed by doctors at or above the deputy director level,and postoperative management and rehabilitation guidance were carried out in accordance with the standardized process.Preoperative / postoperative clinical evaluation included visual analogue score,Lysholm score,oxford knee seessment.At the same time,the joint space width of the affected knees were measured before and after operation,and the affected knees were graded according to Kellgren–Lawrence grade,so as to observe the imaging progress of knee medial interventricular osteoarthritis after operation.Results:There was statistical difference between VAS before operation and VAS at each follow-up time after operation(P < 0.01);The results of Lysholm score,OKS,JSW and K-L grade are the same as before.There was no statistical difference in VAS between 6months and 1 year after operation;The results of Lysholm score,OKS,JSW and K-L grade are the same as before.There was statistical difference between the VAS at 5years after operation and the VAS at 1 year after operation(c)P < 0.05);The results of Lysholm score,OKS,JSW and K-L grade are the same as before.The VAS at 6 months,1 year and 3 years after operation were compared with the VAS at the last follow-up,there were statistical differences among the three groups.(b)c)d)P < 0.05);The results of Lysholm score,OKS,JSW and K-L grade are the same as before.Conclusion: After partial meniscectomy for degenerative MMPRT,the pain of the knee was significantly relieved and the joint function was significantly improved.Arthroscopic partial meniscectomy is a reliable method for the treatment of degenerative MMPRT.The early postoperative effect is worth affirming,but the medium-term and long-term effect is not good.Part2 Analysis of the Reasons for the Progression of Postoperative Medial Arthritis after Partial Meniscectomy for Degenerative MMPRTObjective: During the follow-up of 7.17 ±1.37(mean ± standard deviation)years in patients with degenerative MPPRT treated by partial meniscectomy,some patients(26cases)underwent joint replacement because of medial interarticular osteoarthritis of the affected knee.The purpose of this study is to analyze the risk factors that affect clinical outcomes and to help clinicians identify "high-risk" patients.If these "high-risk" patients are predicted to rapidly develop knee osteoarthritis before operation,and when the potential risk of joint replacement after surgery is hihg,we can consider using other methods to treat degenerative MMPRT or take measures to slow down the progression of arthritis.Methods: The factors that may affect the prognosis,such as sex,age,side,body mass index,preoperative course of disease,joint space width,Kellgren–Lawrence grade,ASA score,VAS,OKS,Lysholm score.According to the inclusion and exclusion criteria,the patients were divided into two groups: replacement group(n = 26)and non-replacement group(n = 158),the differences of various factors between the two groups were compared.Pearson correlation analysis was used to test the correlation.The receiver working characteristic curve was used to evaluate the predictive value of preoperative JSW in postoperative joint replacement and the optimal cutoff value was obtained.Kaplan-Meier method was used for survival analysis,and multivariate Cox regression analysis was used to determine the influencing factors of terminal events.Results:1.The joint space width in the replacement group was significantly lower than that in the non-replacement group,and there was statistical difference between the two groups(P < 0.01).2.Pearson correlation analysis showed that there was a negative correlation between preoperative JSW and postoperative joint replacement(r =-0.3825,P < 0.01).3.The ROC curve was used to evaluate the predictive value of preoperative JSW for postoperative joint replacement.the results showed that the best cut-off point of preoperative JSW for predicting postoperative joint replacement was 4.54 mm,the sensitivity was 73.08%,the specificity was 81.48%,and the area under the curve(AUC)was 0.811(P < 0.01).4.Kaplan-Meier survival analysis showed that the lower preoperative JSW,the higher risk of postoperative joint replacement.5.Multivariate Cox results showed that JSW(HR=0.317,95%,CI:0.105-0.954)was an independent risk factor for prognosis,and JSW was a protective factor.The lower JSW before operation,the faster the progress of osteoarthritis after operation.Conclusion:There was a correlation between preoperative joint space width and the progression of postoperative osteoarthritis.Preoperative JSW is an independent risk factor for the occurrence and progression of knee osteoarthritis after partial meniscectomy for degenerative MMPRT,and it is a protective factor.The lower JSW before operation(JSW < 4.54mm),the faster the occurrence and progression of osteoarthritis after operation.