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2023 中国专家共识指南：外侧盘状半月板（英文）

作者：中华医学网发布时间：2026-01-12 08:30浏览：次

2023 Chinese Experts Consensus and Practice Guideline on Discoid Lateral Meniscus (DLM) 核心解读

This consensus, developed by the Chinese Society of Sports Medicine via the Delphi method, finalizes 18 evidence-based statements covering definition, classification, diagnosis, treatment, rehabilitation, and prognosis, with a core tenet of meniscus preservation first, individualized surgical planning, and standardized rehabilitation to optimize long-term knee function and reduce osteoarthritis risk.

I. Core Consensus Overview (18 statements, >80% expert agreement)

Category	Key Consensus	Evidence Level	Clinical Implication
Definition & Classification	DLM is a congenital lateral meniscus variant; modified Watanabe classification (complete/incomplete/hypermobile) is recommended	High (anatomical & imaging studies)	Standardizes typing for treatment decisions
Diagnosis	MRI is the gold standard; X-ray for screening, arthroscopy for definitive assessment	High (imaging accuracy studies)	Avoid misdiagnosis of other knee pathologies
Treatment	Partial meniscectomy ± repair is first-line; total/subtotal meniscectomy only for irreparable lesions	High (long-term outcome RCTs/registries)	Preserves meniscal function, lowers OA risk
Surgical Principles	Restore normal meniscal shape, retain appropriate width/thickness, ensure remnant stability	High (biomechanical studies)	Prevents postoperative instability & re-tear
Rehabilitation	Early functional exercise, progressive weight-bearing, quadriceps strengthening	Moderate (rehabilitation outcome studies)	Accelerates recovery & maintains knee stability
Prognosis	Long-term follow-up (≥5 years) for OA monitoring; bilateral DLM needs synchronous evaluation	Moderate (long-term cohort studies)	Early intervention for degenerative changes

II. Classification, Diagnosis & Clinical Manifestations

1. Modified Watanabe Classification (Strong Recommendation)

Type	Features	Stability	Clinical Relevance
Complete	Covers entire lateral tibial plateau; normal posterior attachment	Stable	Lower tear risk; saucerization preferred
Incomplete	Semilunar, larger/thicker than normal; normal posterior attachment	Stable	Common in adolescents; partial resection effective
Hypermobile (Wrisberg variant)	Posterior horn lacks normal tibial attachment, only connected via Wrisberg ligament	Unstable	High tear/locking risk; repair + plication recommended

2. Diagnostic Workflow

Clinical Manifestations
- Asymptomatic: Incidental finding (common in adolescents).
- Symptomatic: Knee pain, popping, locking, giving way, limited motion; worse with squatting/rotational activities.
Imaging
- X-ray: Lateral joint space widening, "bow-tie sign" absence (sensitivity 60%-70%).
- MRI: Coronal meniscal width >15 mm, sagittal "bow-tie" on ≥3 consecutive slices (specificity >90%).
Arthroscopy
- Definitive for tear pattern, stability, and posterior attachment status; guides intraoperative decision-making.

3. Differential Diagnosis

Rule out meniscal cysts, lateral collateral ligament injury, osteochondritis dissecans, and synovial chondromatosis via MRI/arthroscopy.

III. Treatment Protocols (Meniscus Preservation as Core)

1. Non - Surgical Indications (Strong Recommendation)

Asymptomatic DLM (no tear, stable): Regular follow - up, lifestyle modification (avoid high - impact sports), quadriceps training.
Symptomatic without tear: NSAIDs, physical therapy, brace immobilization for 2-4 weeks; surgery if no improvement.

2. Surgical Indications (Strong Recommendation)

Symptomatic DLM with tear (locking, persistent pain, instability).
Hypermobile type with recurrent locking/giving way.
Irreversible meniscal degeneration with progressive knee dysfunction.

3. Surgical Techniques (Evidence - Based Priority)

Technique	Indications	Operative Key Points	Postoperative Advantages
Partial Meniscectomy (S saucerization)	Complete/incomplete DLM with localized tear	Reshape to normal semilunar, retain 6-8 mm width	Preserves meniscal function, fast recovery
Partial Meniscectomy + Repair	Repairable tear (longitudinal/oblique) in stable DLM	All - inside/inside - out suture; tension - free closure	Enhances remnant stability, reduces re - tear
Total/Subtotal Meniscectomy	Irreparable extensive tear, destroyed meniscal structure	Minimize resection; balance soft tissue	Only for salvage, high long - term OA risk
Hypermobile Type Repair	Plication + posterior horn reattachment	Anchor/transosseous fixation; restore tibial attachment	Eliminates instability, prevents recurrent locking

IV. Perioperative & Rehabilitation Standards

1. Perioperative Management

Preoperative: Optimize comorbidities (blood glucose, coagulation); MRI 3D reconstruction for surgical planning.
Intraoperative: Arthroscopic real - time assessment of tear/stability; avoid iatrogenic cartilage injury.
Postoperative: Tranexamic acid for hemostasis; multimodal analgesia (nerve block + oral NSAIDs); anticoagulation for 10-14 days.

2. Standardized Rehabilitation Pathway (Moderate Evidence)

Timeframe	Key Exercises	Goals
0-2 Weeks	Ankle pumps, quadriceps isometric contraction, passive ROM (≤90°)	Reduce swelling, prevent muscle atrophy
2-6 Weeks	Active ROM training, partial weight - bearing (10-50% body weight), step - ups	Restore ROM >120°, improve muscle strength
6-12 Weeks	Full weight - bearing, closed - chain exercises (squats <60°), balance training	Restore daily activities, avoid high - impact sports
>12 Weeks	Gradual return to low - impact sports; annual MRI follow - up	Maintain knee function, monitor meniscal degeneration

V. Key Advantages & Clinical Practice Pathway

1. Core Advantages vs. Traditional Protocols

Meniscus Preservation Priority: Reduces long - term OA risk vs. total meniscectomy (5-year OA incidence: 12% vs. 38% in RCTs).
Individualized Surgery: Targets tear type/stability to avoid overtreatment/undertreatment.
Standardized Rehabilitation: Improves functional recovery rate by 30% vs. non - standardized protocols.

2. Clinical Practice Pathway

Symptom + imaging screening → MRI confirmation → DLM classification.
Asymptomatic: Follow - up; symptomatic: Non - surgical treatment for 4 weeks.
Failed non - surgical/tear present: Arthroscopic partial meniscectomy ± repair (hypermobile type with reattachment).
Postoperative rehabilitation → long - term follow - up (5/10 years) for OA monitoring.