Department of Orthopedic Surgery, Veterans Health Service Medical Center, Seoul, Korea.
Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea.
Knee Surg Sports Traumatol Arthrosc. 2018 Aug;26(8):2227-2238. doi: 10.1007/s00167-017-4650-3. Epub 2017 Jul 26.
Implantation of polyurethane (PU) meniscal scaffolds has become a popular procedure to provide a scaffold for vessel ingrowth and meniscal tissue regeneration in patients with partial meniscal defects. However, it is unclear whether PU meniscal scaffolds lead to better clinical and magnetic resonance imaging (MRI) outcomes post-operatively. This meta-analysis compared the clinical and MRI outcomes in patients with partial meniscal defects treated with PU meniscal scaffolds.
This meta-analysis reviewed all studies that assessed Lysholm score, International Knee Documentation Committee (IKDC) score, visual analogue scale (VAS) for pain, Tegner score, Knee Injury and Osteoarthritis Outcomes Score (KOOS), articular cartilage (AC), absolute meniscal extrusion (AME), morphology and size (MS), signal intensity (SI) of meniscal implant, and interface of the implant-residual meniscus complex (IIRMC) in patients with partial meniscal defects treated with PU meniscal scaffolds.
Eighteen studies were included in the meta-analysis. The proportion of patients who evaluated MS (OR 0.71, 95% CI 0.38-1.33; n.s.), SI (OR 1.07, 95% CI 0.53-2.18; n.s.), and IIRMC (OR 1.00, 95% CI 0.33-3.06; n.s.) did not differ significantly between baseline and final follow-up. However, AC (OR 0.31, 95% CI 0.11-0.84; P = 0.02) and AME (OR 0.05, 95% CI 0.01-0.18; P < 0.00001) worsened between baseline and final follow-up. Conversely, Lysholm score (95% CI -1.87 to -1.07; P < 0.00001), IKDC score (95% CI -2.19 to -1.08; P < 0.00001), VAS for pain (95% CI -2.29 to -1.07; P < 0.00001), Tegner score (95% CI -0.76 to -0.15; P = 0.003), and overall KOOS (95% CI -29.48 to -23.17; P < 0.00001) were significantly greater at final follow-up when compared to baseline.
This meta-analysis found no significant differences in the tested MRI parameters, including MS, SI, and IIRMC. However, AC and AME worsened between baseline and final follow-up. Conversely, patients treated with PU meniscal scaffolds showed significant functional improvement and pain relief when compared with baseline scores. Thus, PU meniscal scaffolds appear to be a viable alternative for patients with partial meniscal defects, although further studies are needed to determine whether worsened AC and AME are clinically relevant. In particular, precise measurement of PU meniscal scaffolds in combination with thorough investigation of the baseline articular cartilage status and meniscal defect size may be effective for pain relief or functional improvement in patients with PU meniscal scaffold implantation.
III.
在患有部分半月板损伤的患者中，植入聚氨酯（PU）半月板支架已成为一种流行的方法，可为血管生成和半月板组织再生提供支架。然而，目前尚不清楚 PU 半月板支架是否会在术后带来更好的临床和磁共振成像（MRI）结果。本荟萃分析比较了接受 PU 半月板支架治疗的部分半月板损伤患者的临床和 MRI 结果。
本荟萃分析评估了接受 PU 半月板支架治疗的部分半月板损伤患者的 Lysholm 评分、国际膝关节文献委员会（IKDC）评分、疼痛视觉模拟量表（VAS）、Tegner 评分、膝关节损伤和骨关节炎结果评分（KOOS）、关节软骨（AC）、绝对半月板挤出（AME）、形态和大小（MS）、半月板植入物的信号强度（SI）以及植入物-残留半月板复合体的界面（IIRMC）。
共有 18 项研究纳入荟萃分析。在基线和最终随访时，MS（OR 0.71，95%CI 0.38-1.33；n.s.）、SI（OR 1.07，95%CI 0.53-2.18；n.s.）和 IIRMC（OR 1.00，95%CI 0.33-3.06；n.s.）的患者比例无显著差异。然而，AC（OR 0.31，95%CI 0.11-0.84；P=0.02）和 AME（OR 0.05，95%CI 0.01-0.18；P<0.00001）在基线和最终随访之间恶化。相反，Lysholm 评分（95%CI-1.87 至-1.07；P<0.00001）、IKDC 评分（95%CI-2.19 至-1.08；P<0.00001）、疼痛 VAS（95%CI-2.29 至-1.07；P<0.00001）、Tegner 评分（95%CI-0.76 至-0.15；P=0.003）和整体 KOOS（95%CI-29.48 至-23.17；P<0.00001）在最终随访时明显大于基线。
本荟萃分析发现，在测试的 MRI 参数中，包括 MS、SI 和 IIRMC，均无显著差异。然而，AC 和 AME 在基线和最终随访之间恶化。相反，与基线评分相比，接受 PU 半月板支架治疗的患者表现出显著的功能改善和疼痛缓解。因此，PU 半月板支架似乎是治疗部分半月板损伤患者的可行选择，尽管需要进一步的研究来确定 AC 和 AME 的恶化是否具有临床意义。特别是，PU 半月板支架的精确测量与关节软骨状况和半月板损伤大小的全面调查相结合，可能有助于接受 PU 半月板支架植入的患者缓解疼痛或改善功能。
III 级。
