自体纤维蛋白凝块增强翻修修复失败的桶柄状内侧半月板撕裂：一例随访一年的病例报告

摘要(中文译文)

半月板在维持膝关节功能和预防早期骨关节炎方面具有重要作用，因此半月板保留越来越受到青睐。然而，初次半月板修复失败仍是一个具有挑战性的临床问题，最佳的翻修策略尚未明确建立。纤维蛋白凝块增强已被探索作为一种潜在技术，用于促进翻修半月板修复中的愈合。我们报告一例30岁男性患者，其在关节镜下修复内侧半月板桶柄状撕裂后出现症状复发。该患者最初因左膝扭伤受伤，于2025年3月接受关节镜下半月板修复术。尽管进行了术后康复，他仍于2025年6月出现复发性疼痛和机械症状。同月进行的磁共振成像提示初次修复失败。随后于2025年6月21日行翻修关节镜检查，发现内侧半月板桶柄状撕裂持续存在于红白区，与既往修复失败一致。在新鲜化撕裂边缘后，将通过30 mL外周静脉血制备的自体纤维蛋白凝块在关节镜下引入病变部位。随后使用五针由外向内缝线完成半月板修复。在一年随访时，患者报告疼痛完全缓解，无交锁发作和不稳定，并成功恢复工作和体育活动。临床检查显示膝关节稳定，活动范围完整。术后Lysholm评分为100/100，表明功能结果优良。本病例突出了自体纤维蛋白凝块增强在翻修半月板修复中的潜在价值，并支持将半月板保留作为桶柄状内侧半月板撕裂初次修复失败后的可行治疗选择。一年随访时观察到优良的临床结果，尽管由于未进行术后MRI或二次关节镜检查，无法确认结构性愈合。

Abstract

Meniscal preservation is increasingly favored because of the essential role of the meniscus in maintaining knee function and preventing early osteoarthritis. However, failure of primary meniscal repair remains a challenging clinical situation, and optimal revision strategies are not clearly established. Fibrin clot augmentation has been explored as a potential technique to enhance healing in revision meniscal repair. We report the case of a 30-year-old male who developed recurrent symptoms after arthroscopic repair of a bucket-handle tear of the medial meniscus. The patient initially sustained a twisting injury to the left knee and underwent arthroscopic meniscal repair in March 2025. Despite postoperative rehabilitation, he developed recurrent pain and mechanical symptoms in June 2025. Magnetic resonance imaging performed the same month suggested failure of the initial repair. Revision arthroscopy was subsequently performed on June 21, 2025, and revealed a persistent bucket-handle tear of the medial meniscus located in the red-white zone, consistent with failure of the previous repair. After refreshing the tear edges, an autologous fibrin clot prepared from 30 mL of peripheral venous blood was introduced arthroscopically into the lesion site. Meniscal repair was then completed using five outside-in sutures. At one-year follow-up, the patient reported complete resolution of pain, absence of locking episodes and instability, and successful return to work and sports activities. Clinical examination demonstrated a stable knee with full range of motion. The postoperative Lysholm score was 100/100, indicating an excellent functional outcome. This case highlights the potential value of autologous fibrin clot augmentation in revision meniscal repair and supports meniscal preservation as a viable treatment option after failure of primary repair of a bucket-handle medial meniscal tear. An excellent clinical outcome was observed at one-year follow-up, although structural healing could not be confirmed because postoperative MRI or second-look arthroscopy was not performed.

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