Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence in Research and Learning (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
Arthroscopy. 2017 Oct;33(10):1884-1895. doi: 10.1016/j.arthro.2017.04.006. Epub 2017 Jun 24.
To evaluate the surgical treatment of the discoid lateral meniscus (DLM) with long-term follow-up and to search which factors are related to good clinical or radiological outcomes.
Search was performed using a MEDLINE, EMBASE, and Cochrane database, and each of the selected studies was evaluated for methodological quality using a risk of bias (ROB) covering 7 criteria. Clinical and radiological outcomes with more than 5 years of follow-up were evaluated after surgical treatment of DLM. They were analyzed according to the age, follow-up period, kind of surgery, DLM type, and alignment.
Eleven articles (422 DLM cases) were included in the final analysis. Among 7 criteria, 3 criteria showed little ROB in all studies. However, 4 criteria showed some ROB ("Yes" in 63.6% to 81.8%). The minimal follow-up period was 5.5 years (weighted mean follow-up: 9.1 years). Surgical procedures were performed with open or arthroscopic partial central meniscectomy, subtotal meniscectomy, total meniscectomy, or partial meniscectomy with repair. The majority of the studies showed good clinical results. Mild joint space narrowing was reported in the lateral compartment, but none of the knees demonstrated moderate or advanced degenerative changes. Increased age at surgery, longer follow-up period, and subtotal or total meniscectomy could be related to degenerative change. The majority of the complications was osteochondritis dissecans at the lateral femoral condyle (13 cases) and reoperation was performed by osteochondritis dissecans (4 cases), recurrent swelling (2 cases), residual symptom (1 case), stiffness (1 case), and popliteal stenosis (1 case).
Good clinical results were obtained with surgical treatment of symptomatic DLM. The progression of degenerative change was minimal and none of the knees demonstrated moderate or advanced degenerative changes. Increased age at surgery, longer follow-up period, and subtotal or total meniscectomy were possible risk factors for degenerative changes.
Level IV, systematic review of Level IV studies.
通过长期随访评估盘状外侧半月板（DLM）的手术治疗，并寻找与良好临床或影像学结果相关的因素。
使用 MEDLINE、EMBASE 和 Cochrane 数据库进行搜索，并使用涵盖 7 个标准的偏倚风险（ROB）评估每个选定研究的方法学质量。对 DLM 手术后超过 5 年的临床和影像学结果进行评估。根据年龄、随访时间、手术类型、DLM 类型和对线情况进行分析。
最终分析纳入 11 篇文章（422 例 DLM 病例）。在 7 个标准中，有 3 个标准在所有研究中均显示 ROB 较小。然而，有 4 个标准显示出一些 ROB（“是”占 63.6%至 81.8%）。最短随访时间为 5.5 年（加权平均随访时间：9.1 年）。手术方法包括开放性或关节镜下部分中央半月板切除术、次全切除术、全切除术或半月板部分切除术加修复术。大多数研究显示出良好的临床结果。外侧间室报告有轻度关节间隙狭窄，但无膝关节显示出中度或晚期退行性改变。手术时年龄较大、随访时间较长以及次全或全切除术可能与退行性改变有关。大多数并发症为外侧股骨髁骨软骨炎（13 例），并进行了骨软骨炎切除术（4 例）、复发性肿胀（2 例）、残留症状（1 例）、僵硬（1 例）和腘窝狭窄（1 例）。
对有症状的 DLM 进行手术治疗可获得良好的临床结果。退行性改变的进展很小，无膝关节显示出中度或晚期退行性改变。手术时年龄较大、随访时间较长以及次全或全切除术可能是退行性改变的危险因素。
四级，四级研究的系统评价。
