Department of Clinical Epidemiology, Biostatistics and Bioinformatics, University of Amsterdam, Amsterdam, the Netherlands.
J Orthop Sports Phys Ther. 2013 Jun;43(6):352-67. doi: 10.2519/jospt.2013.4295. Epub 2013 Apr 29.
Systematic review with meta-analysis.
To review and critically appraise the literature for factors that increase the risk for meniscal tears.
Meniscal tears are an important cause of disability and time lost from work, and are associated with a 4-fold increase in the long-term risk of knee osteoarthritis. Knowledge of the risk factors that lead to meniscal tears can help to correctly diagnose knee injuries and is important to the development of prevention strategies for knee osteoarthritis.
A search of the Cochrane Database of Systematic Reviews, MEDLINE, and Embase, from 1950 to January 2012, and a hand search of reference lists of all initially selected studies, without restriction on language or date of publication, were conducted. Prospective, retrospective, and case-control studies that included individuals over 16 years of age, who had no previous meniscal injuries or surgeries, were selected. A meta-analysis for 17 risk factors was performed. Where considerable heterogeneity among studies was present or the data did not provide sufficient information to perform a meta-analysis, a qualitative synthesis was conducted.
Eleven studies, with a total of 7358 participants, were selected for systematic review. Data were available for meta-analysis for 10 of the 11 studies. Qualitative analysis was conducted using data from 3 of the 11 studies. Results showed strong evidence that age (older than 60 years), gender (male), work-related kneeling and squatting, and climbing stairs (greater than 30 flights) were risk factors for degenerative meniscal tears. We also found strong evidence that playing soccer and playing rugby were strong risk factors for acute meniscal tears. Waiting longer than 12 months between the anterior cruciate ligament injury and reconstructive surgery was a strong risk factor for a medial meniscal tear but not for a lateral meniscal tear.
The literature indicates a number of risk factors leading to either degenerative or acute meniscal tears, with some of these factors being potentially modifiable.
Prognosis, level 2a.
系统评价与荟萃分析。
回顾和批判性评估增加半月板撕裂风险的相关文献。
半月板撕裂是导致残疾和丧失工作时间的一个重要原因，与膝关节骨关节炎长期风险增加 4 倍有关。了解导致半月板撕裂的危险因素有助于正确诊断膝关节损伤，对于制定膝关节骨关节炎预防策略也非常重要。
对 Cochrane 系统评价数据库、MEDLINE 和 Embase 进行了 1950 年至 2012 年 1 月的检索，同时还对所有最初筛选出的研究的参考文献进行了手工检索，未对语言或发表日期进行限制。纳入的研究为观察性研究（前瞻性、回顾性和病例对照研究），研究对象为年龄超过 16 岁、既往无半月板损伤或手术史的人群。对 17 个危险因素进行荟萃分析。如果研究间存在较大的异质性，或数据无法提供足够的信息进行荟萃分析，则进行定性综合分析。
11 项研究共纳入 7358 名参与者，对其进行系统评价。11 项研究中的 10 项研究的数据可用于荟萃分析。对 11 项研究中的 3 项研究的数据进行了定性分析。结果显示，年龄（大于 60 岁）、性别（男性）、与工作相关的跪地和蹲姿、爬楼梯（大于 30 级）是退行性半月板撕裂的危险因素，具有很强的证据支持。我们还发现，踢足球和打橄榄球是急性半月板撕裂的强烈危险因素。前交叉韧带损伤与重建手术之间的等待时间超过 12 个月是内侧半月板撕裂的一个强烈危险因素，但不是外侧半月板撕裂的危险因素。
文献表明了一些导致退行性或急性半月板撕裂的危险因素，其中一些因素可能是可以改变的。
预后，2a 级。
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