Lub meniscus tau muab faib ua qhov nruab nrab thiab sab nraud. Txhua lub meniscus tuaj yeem muab faib ntxiv rau hauv lub cev sab hauv, lub cev, thiab lub cev tom qab. Cov kua muag nyob rau hauv cov cheeb tsam sib txawv muaj qhov sib txawv tseem ceeb ntawm cov qauv anatomical, cov ntshav txaus, thiab ib puag ncig kev kho tshuab, nthuav tawm cov kev sib tw sib txawv rau kev tsim cov koob kho meniscus thiab cov txheej txheem kev ua haujlwm. Kev nkag siab txog qhov sib txawv no yog tus yuam sij rau kev paub txog cov txheej txheem kho meniscus.

Tom qab horn tsim kua muag yog hom kev sib tw tshaj plaws. Lub cev tom qab ntawm lub nruab nrab meniscus yog nyob ib sab ntawm lub posterior cruciate ligament thiab popliteal tendon, thiab qhov chaw yog qhov nqaim heev. Cov txheej txheem suture yog ib qho nyuaj rau ua ntawm no. Qhov zoo ntawm cov koob kho meniscus tau pom meej ntawm no: lub cev lub cev muaj zog tuaj yeem hla qhov nruab nrab femoral condyle thiab ncav cuag qhov chaw tom qab horn tsim kua muag nyob rau hauv kev saib xyuas arthroscopic. Vim yog qhov tshwj xeeb ntawm lub cev ntawm lub cev tom qab, qee cov koob kho tau tsim nrog lub kaum sab xis ua ntej -khoov (feem ntau yog 15℃- 25 degree), tso cai rau lub taub hau kom zoo ib yam nrog lub kua muag nto. Thaum lub sijhawm ua haujlwm, tus kws kho mob yuav tsum tau muab lub hauv caug tso rau hauv "4-point txoj hauj lwm" (hip externally rotated thiab abducted, pob luj taws tso rau ntawm lub hauv caug sab nraud) kom nthuav dav qhov nruab nrab nruab nrab ntawm qhov sib txawv thiab tsim qhov chaw ua haujlwm rau kev kho koob.

Kev kho mob ntawm lub cev tsim kua muag yog qhov yooj yim dua, tab sis qhov yuav tsum tau kho lub zog yog qhov siab tshaj plaws. Lub cev ib feem ntawm lub meniscus dais feem ntau ntawm cov axial load, thiab cov sutures ntawm no yuav tsum tau tiv taus tensile zog ntawm ntau tshaj 100 Newtons. Thaum kho cov kua muag nyob rau hauv lub cev ib feem ntawm lub meniscus, lub meniscus kho koob feem ntau siv txoj kev "ntim txaj" suture, nrog rau cov suture perpendicular mus rau lub collagen fibers, muab lub zog tensile zog. Txhawm rau kom ruaj khov kho, cov kws kho mob feem ntau tso 2-3 cov ntsia hlau thauj tog rau nkoj, nrog rau qhov sib nrug ntawm 5 millimeters. Cov cim ntsuas ntawm cov koob kho niaj hnub no tuaj yeem pab cov kws kho mob kom tswj tau cov koob txhaj tshuaj qhov tob, tsis txhob ua rau cov pob txha mos los ntawm kev nkag mus rau hauv qab ntawm lub meniscus.

Lub pob txha pob txha sab hauv yog qhov tsis tshua muaj hauv kev kho mob, tab sis nws txoj kev kho mob tsis yooj yim. Cov ntaub so ntswg meniscus nyob rau hauv lub anterior horn cheeb tsam yog nyias thiab muaj cov ntshav tsis zoo, muaj peev xwm kho tsis tau. Tsis tas li ntawd, lub taub hau sab hauv yog nyob ze rau ntawm cov ntaub so ntswg infrapatellar thiab cov patellar tendon, thiab nws muaj feem cuam tshuam nrog cov ntaub so ntswg mos thaum ua haujlwm. Daim ntawv thov kho meniscus koob ntawm qhov chaw no yuav tsum tau ceev faj ntxiv: qhov taw tes ntxig yuav tsum nyob ze rau ntawm ntug meniscus li sai tau, thiab thaum lub suture hla dhau, xyuas kom meej tias nws muaj qhov dav txaus ntawm cov ntaub so ntswg (tsawg kawg 3 millimeters); txwv tsis pub, lub suture yog feem ntau raug txiav. Rau cov kua muag radial nyob rau hauv lub anterior horn, qee tus kws kho mob yuav siv cov txheej txheem "tag nrho sab hauv tus ntoo khaub lig", tsim ib daim phiaj-zoo li fixation nrog ob txoj hlua kho kom tawg mus rau kev ntxhov siab.

Sib nrug los ntawm qhov sib txawv ntawm qhov chaw, cov duab ntawm cov kua muag kuj cuam tshuam rau qhov kev xaiv ntawm kev kho koob. Longitudinal kua muag (hom feem ntau yog lub thoob- tuav- cov kua muag zoo li tus) yog tsim rau ntsug txaj suturing, qhov twg cov koob kho yuav tsum tau muab tso rau ntawm ib sab ntawm lub kua muag, hla lub kua muag sib txawv, thiab tom qab ntawd tawm ntawm sab nraud. Kab rov tav kua muag yog tsim rau kab rov tav suturing lub txaj, qhov chaw kho koob yog kis mus rau tib lub meniscus nto, nqa lub sab sauv thiab qis lamellae ua ke. Rau kev sib xyaw ua kua kua muag, ntau cov txheej txheem suture tej zaum yuav tsum tau ua ke, thiab qhov hloov pauv ntawm lub koob kho kom hloov cov xov yog qhov tseem ceeb tshwj xeeb.

Cov ntshav muab ntshav yog lwm qhov tseem ceeb ntawm kev txiav txim siab kho lub tswv yim. Cov ntshav ntawm meniscus los ntawm cov ceg ntawm cov hlab ntsha ntawm lub hauv ntej thiab tom qab ntawm lub hauv caug, npog tsuas yog 10% mus rau 30% ntawm thaj chaw sab nraud (thaj chaw liab), thaum lub hauv paus cheeb tsam (thaj chaw dawb) yuav luag tsis muaj ntshav. Kev kho tus nqi ntawm cov kua muag hauv thaj tsam liab tuaj yeem ncav cuag ntau dua 90%, thaum nyob hauv thaj chaw dawb yog tsawg dua 50%. Lwm qhov kev siv tshiab ntawm lub koob kho meniscus yog "kev kho mob lom neeg": thaum lub sij hawm suturing, lub hollow channel ntawm koob kho yog siv los txhaj platelet-nplua nuj plasma (PRP) los yog pob txha pob txha mloog zoo, muab kev loj hlob rau cov uas tsis yog- ntshav- muab cov chaw thiab txhawb kev kho mob. Qhov kev ua haujlwm thib ob ntawm "kev xa tshuaj + kev kho kho tshuab" tau dhau los ua cov kev taw qhia tshiab rau kev txhim kho cov koob kho meniscus.

Finally, the post-operative rehabilitation plan must also be adjusted according to the location of the tear. After posterior horn repair, deep squats and extreme knee flexion (>90 degree) yuav tsum tau zam kom tsis txhob muaj zog ntau dhau ntawm cov sutures; tom qab nruab nrab- kho ib feem, kev hloov pauv yuav tsum tau txwv, tshwj xeeb tshaj yog nres thiab hloov kev taw qhia; Tom qab kho anterior horn, ntau ntxiv ntawm lub hauv caug pob qij txha yuav tsum tau zam. Qhov muaj zog fixation muab los ntawm cov koob kho meniscus ua rau kev siv ntawm cov kev npaj kho mob ntawm tus kheej, thaum kawg ua tiav qhov kev ua haujlwm zoo tshaj plaws.