Fillingham Yale A, Riboh Jonathan C, Erickson Brandon J, Bach Bernard R, Yanke Adam B
Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.
Am J Sports Med. 2017 Jan;45(1):234-242. doi: 10.1177/0363546516632504. Epub 2016 Jul 21.
Meniscal tears are common in the young, active population. In this group of patients, repair is advised when possible. While inside-out repair remains the standard technique, recent advances in all-inside repair devices have led to a growth in their popularity. Previous reviews on the topic have focused on outdated implants of limited clinical relevance.
To determine the difference in failure rates, functional outcomes, and complications between inside-out and modern all-inside repairs.
Systematic review.
A systematic review was registered with PROSPERO and performed following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines using the MEDLINE, EMBASE, and Cochrane databases. Inclusion criteria were (1) clinical study reporting on all-inside or inside-out repair, (2) evidence levels 1 to 4, and (3) use of modern all-inside implants for all-inside repairs. Exclusion criteria were (1) use of meniscal arrows or screws and (2) concomitant surgical procedures. Study characteristics, subjects, surgical technique, clinical outcomes, and complications were collected and analyzed.
A total of 481 studies were screened and assessed for eligibility, which identified 27 studies for review. Studies defined clinical failure as persistent mechanical symptoms, effusion, or joint line tenderness, while anatomic failure was incomplete or no healing on MRI or second-look arthroscopy. There were no significant differences in clinical or anatomic failure rates between inside-out and all-inside repairs (clinical failure: 11% vs 10%, respectively, P = .58; anatomic failure: 13% vs 16%, respectively, P = .63). Mean ± SD Lysholm and Tegner scores for inside-out repair were 88.0 ± 3.5 and 5.3 ± 1.2, while the respective scores for all-inside repair were 90.4 ± 3.7 and 6.3 ± 1.3. Complications occurred at a rate of 5.1% for inside-out repairs and 4.6% for all-inside repairs.
The quality of the evidence comparing inside-out and all-inside meniscal repair remains low, with a majority of the literature being evidence level 4 studies. In this review comparing modern all-inside devices with inside-out repair, no differences were seen in failure rates, functional outcome scores, or complication rates.
半月板撕裂在年轻、活跃人群中很常见。对于这类患者，建议尽可能进行修复。虽然由外向内修复仍是标准技术，但全内修复装置的最新进展使其越来越受欢迎。以往关于该主题的综述主要关注临床相关性有限的过时植入物。
确定由外向内修复与现代全内修复在失败率、功能结果和并发症方面的差异。
系统评价。
在PROSPERO上注册了一项系统评价，并按照系统评价和Meta分析的首选报告项目（PRISMA）指南，使用MEDLINE、EMBASE和Cochrane数据库进行。纳入标准为：（1）关于全内或由外向内修复的临床研究报告；（2）证据水平为1至4；（3）全内修复使用现代全内植入物。排除标准为：（1）使用半月板箭头或螺钉；（2）同时进行的外科手术。收集并分析研究特征、受试者、手术技术、临床结果和并发症。
共筛选并评估了481项研究的 eligibility，确定了27项研究进行综述。研究将临床失败定义为持续的机械症状、积液或关节线压痛，而解剖学失败定义为MRI或二次关节镜检查显示愈合不完全或未愈合。由外向内修复和全内修复在临床或解剖学失败率方面无显著差异（临床失败：分别为11%和10%，P = 0.58；解剖学失败：分别为13%和16%，P = 0.63）。由外向内修复的平均±标准差Lysholm和Tegner评分分别为88.0±3.5和5.3±1.2，而全内修复的相应评分为90.4±3.7和6.3±1.3。由外向内修复的并发症发生率为5.1%，全内修复为4.6%。
比较由外向内和全内半月板修复的证据质量仍然较低，大多数文献为证据水平4的研究。在本综述中，比较现代全内装置与由外向内修复时，在失败率、功能结果评分或并发症发生率方面未发现差异。
