Department of Orthopedic Surgery-Sports Medicine Service, Massachusetts General Hospital, 175 Cambridge St, Suite 400, Boston, MA, 02114, USA.
Knee Surg Sports Traumatol Arthrosc. 2022 Jun;30(6):1915-1926. doi: 10.1007/s00167-021-06849-5. Epub 2022 Mar 8.
Orthopedic literature remains divided on the utility of biologic augmentation to optimize outcomes after isolated meniscal repair. The aim of this systematic review is to analyze the clinical outcomes and re-operation rates of biologically augmented meniscal repairs.
PubMed, CINAHL, Cochrane, and EMBASE databases were queried in October 2020 for published literature on isolated meniscal repair with biological augmentation. Studies were assessed for quality and risk of bias by two appraisal tools. Patient demographics, meniscal tear characteristics, surgical procedure, augmentation type, post-operative rehabilitation, patient reported outcome measures, and length of follow-up were recorded, reviewed, and analyzed by two independent reviewers.
Of 3794 articles, 18 met inclusion criteria and yielded 537 patients who underwent biologic augmentation of meniscal repair. The biologically augmented repair rates were 5.8-27.0% with PRP augmentation, 0.0-28.5% with fibrin clot augmentation, 0.0-12.9% with marrow stimulation, and 0.0% with stem cell augmentation. One of seven studies showed lower revision rates with augmented meniscal repair compared to standard repair techniques, whereas five of seven found no benefit. Three of ten studies found significant functional improvement of biologically augmented repair versus standard repair techniques and six of ten studies found no difference. There was significant heterogeneity in methods for biologic preparation, delivery, and post-operative rehabilitation protocols.
Patients reported significant improvements in functional outcomes scores after repair with biological augmentation, though the benefit over standard repair controls is questionable. Revision rates after biologically augmented meniscal repair also appear similar to standard repair techniques. Clinicians should bear this in mind when considering biologic augmentation in the setting of meniscal repair.
IV.
矫形文献仍然存在分歧，即生物增强是否有助于优化半月板修复后的结果。本系统评价旨在分析生物增强半月板修复的临床结果和再次手术率。
2020 年 10 月，通过 PubMed、CINAHL、Cochrane 和 EMBASE 数据库查询有关生物增强半月板修复的已发表文献。使用两种评价工具评估研究的质量和偏倚风险。记录、审查和分析两名独立审查员的患者人口统计学、半月板撕裂特征、手术过程、增强类型、术后康复、患者报告的结果测量和随访时间。
在 3794 篇文章中，有 18 篇符合纳入标准，共纳入 537 例接受半月板修复生物增强的患者。PRP 增强修复率为 5.8-27.0%，纤维蛋白凝块增强修复率为 0.0-28.5%，骨髓刺激增强修复率为 0.0-12.9%，干细胞增强修复率为 0.0%。有 1 项研究的 7 项研究显示，与标准修复技术相比，增强半月板修复的翻修率较低，而有 5 项研究显示无获益。有 3 项研究的 10 项研究发现，生物增强修复与标准修复技术相比，功能改善有显著意义，而有 6 项研究发现无差异。生物制剂的准备、输送和术后康复方案的方法存在显著异质性。
患者报告称，在半月板修复中使用生物增强后，功能结果评分有显著改善，但与标准修复对照相比，其益处值得怀疑。生物增强半月板修复后的翻修率似乎也与标准修复技术相似。临床医生在考虑半月板修复时应考虑生物增强。
IV 级。
