Department of Orthopedics, Division of Sports Medicine and Shoulder Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA.
The Steadman Clinic, Vail, Colorado, USA.
Am J Sports Med. 2020 Nov;48(13):3386-3393. doi: 10.1177/0363546520906141. Epub 2020 Mar 20.
There is no consensus on technique of choice for repair of bucket-handle meniscal tears (BHMTs).
To determine factors that affect patient outcomes and failure rates in patients undergoing all-inside repairs of BHMTs.
Systematic review.
A systematic review of 3 databases using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines was performed. All English-language literature from 1993 to 2019 describing clinical outcomes for patients undergoing all-inside BHMT repair with ≥12-month follow-up was reviewed by 2 independent reviewers. Patient characteristics (patient sex, age), intraoperative factors (laterality, concomitant procedures, surgical technique, implants utilized), and postoperative outcomes (failure rates) were analyzed. Study quality was evaluated with the Modified Coleman Methodology Score (MCMS).
Fifteen studies (1 level 1, 4 level 3, 10 level 4) with 763 total patients (64% male; average age, 26.4 years [range, 9-58 years]; average follow-up, 39.8 months [range, 12-120 months]) including 396 all-inside BHMT repairs were included. Six devices were used for repair including the Meniscal Repair System, FasT-Fix, Meniscus Arrow, Biofix Arrow, RapidLoc device, and PDS II suture, with failure rates of 13.5%, 22.4%, 27.1%, 42.9%, 45.2%, and 0%, respectively. The overall repair failure rate was 29.3% at an average of 13.0 months (range, 5.0-32.4 months), but 19.0% for devices still in use. The RapidLoc and Biofix Arrow had higher failure rates than other devices ( = .0003). Women (31%) were less likely to experience a failure than were men (69%) ( = .03). Longer follow-up duration resulted in higher failure rates (>30 months, 34.4%; <30 months, 23.4%; = .016). In 4 studies reporting on both all-inside and inside-out repairs, no significant differences in failure rates were observed. No significant differences in failure rates were found between medial and lateral repairs nor repair with and without concurrent anterior cruciate ligament reconstruction ( > .05 for all). The overall average MCMS was 54.4 ± 12.
The overall failure rate after all-inside repair of BHMTs is 29.3% at an average of 13.0 months, with no difference in failure rates between medial and lateral meniscal repairs. The variables shown to negatively affect the failure rates were the RapidLoc and Biofix Arrow, male sex, and longer follow-up duration.
对于桶柄状半月板撕裂（BHMT）的修复，目前尚无首选技术的共识。
确定影响全内修复 BHMT 患者结局和失败率的因素。
系统评价。
对 3 个数据库进行了系统评价，使用 PRISMA（系统评价和荟萃分析的首选报告项目）指南。对 1993 年至 2019 年间描述了全内 BHMT 修复后至少 12 个月随访的患者临床结局的所有英文文献进行了 2 位独立审查员的审查。分析了患者特征（患者性别、年龄）、术中因素（侧别、伴随手术、手术技术、使用的植入物）和术后结局（失败率）。使用改良 Coleman 方法学评分（MCMS）评估研究质量。
共纳入 15 项研究（1 项 1 级，4 项 3 级，10 项 4 级），共 763 例患者（64%为男性；平均年龄 26.4 岁[范围，9-58 岁]；平均随访 39.8 个月[范围，12-120 个月]），其中 396 例行全内 BHMT 修复。用于修复的 6 种器械包括半月板修复系统、FasT-Fix、半月板箭头、Biofix 箭头、RapidLoc 装置和 PDS II 缝线，其失败率分别为 13.5%、22.4%、27.1%、42.9%、45.2%和 0%。平均 13.0 个月（范围，5.0-32.4 个月）的总体修复失败率为 29.3%，但仍在使用的器械的失败率为 19.0%。RapidLoc 和 Biofix 箭头的失败率高于其他器械（ =.0003）。女性（31%）比男性（69%）更不易发生失败（ =.03）。随访时间延长导致失败率升高（>30 个月，34.4%；<30 个月，23.4%； =.016）。在 4 项同时报告全内和内翻修复的研究中，未观察到失败率存在显著差异。内侧和外侧半月板修复以及是否同时行前交叉韧带重建术之间的失败率也无显著差异（>0.05）。总体平均 MCMS 为 54.4±12.
全内修复 BHMT 的总体失败率为 13.0 个月时的 29.3%，内侧和外侧半月板修复的失败率无差异。显示对失败率有负面影响的变量是 RapidLoc 和 Biofix 箭头、男性性别和较长的随访时间。
