Washington University School of Medicine, St. Louis, Missouri.
Vanderbilt University, Nashville, Tennessee.
J Bone Joint Surg Am. 2022 Jul 20;104(14):1311-1320. doi: 10.2106/JBJS.21.01303. Epub 2022 Apr 19.
The utilization of meniscal repair techniques continues to evolve in an effort to maximize the rate of healing. Meniscal repair outcomes at a minimum of 5 years postoperatively appear to better represent the true failure rates. Thus, a systematic review and meta-analysis of the current literature was conducted to assess the rate of failure at a minimum of 5 years after meniscal repair.
We performed a systematic review of studies reporting the outcomes of meniscal repair at a minimum of 5 years postoperatively. A standardized search and review strategy was utilized. Failure was defined as recurrent clinical symptoms or a meniscal reintervention to repair or resect the meniscus in any capacity, as defined by the study. When reported, outcomes were assessed relative to anterior cruciate ligament (ACL) status, sex, age, and postoperative rehabilitation protocol. Meta-analyses were performed with a random-effects model.
A total of 27 studies of 1,612 patients and 1,630 meniscal repairs were included in this review and meta-analysis. The pooled overall failure rate was 22.6%, while the failure rate of modern repairs (excluding early-generation all-inside devices) was 19.5%. Medial repairs were significantly more likely to fail compared with lateral repairs (23.9% versus 12.6%, p = 0.04). Failure rates were similar for inside-out (14.2%) and modern all-inside repairs (15.8%). Early-generation all-inside devices had a significantly higher failure rate (30.2%) compared with modern all-inside devices (15.8%, p = 0.01). There was no significant difference in meniscal failure rate between repairs with concomitant ACL reconstruction (21.2%) and repairs in ACL-intact knees (23.3%, p = 0.54).
Modern meniscal repair had an overall failure rate of 19.5% at a minimum of 5 years postoperatively. Modern all-inside techniques appear to have improved the success rate of meniscal repair compared with use of early-generation all-inside devices. Lateral repairs were significantly more likely to be successful compared with medial repairs, while no difference was seen between patients undergoing meniscal repair with and without concomitant ACL reconstruction.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
为了最大限度地提高愈合率，半月板修复技术的应用不断发展。术后至少 5 年的半月板修复结果似乎更能代表真实的失败率。因此，对当前文献进行了系统回顾和荟萃分析，以评估术后至少 5 年半月板修复的失败率。
我们对至少术后 5 年报道半月板修复结果的研究进行了系统回顾。采用标准化的搜索和审查策略。失败的定义为研究中定义的任何程度的临床症状复发或半月板再干预，以修复或切除半月板。当报告时，根据前交叉韧带（ACL）状态、性别、年龄和术后康复方案评估结果。采用随机效应模型进行荟萃分析。
共纳入 27 项研究，涉及 1612 名患者和 1630 例半月板修复。该综述和荟萃分析共纳入 27 项研究，涉及 1612 名患者和 1630 例半月板修复。总体失败率为 22.6%，而现代修复（不包括早期全内装置）的失败率为 19.5%。内侧修复与外侧修复相比，失败的可能性明显更高（23.9%比 12.6%，p=0.04）。经皮和现代全内修复的失败率相似（14.2%和 15.8%）。早期全内装置的失败率明显高于现代全内装置（30.2%比 15.8%，p=0.01）。伴 ACL 重建的半月板修复与 ACL 完整膝关节的半月板修复的失败率无显著差异（21.2%和 23.3%，p=0.54）。
现代半月板修复术后至少 5 年的总体失败率为 19.5%。与使用早期全内装置相比，现代全内技术似乎提高了半月板修复的成功率。与内侧修复相比，外侧修复更有可能成功，而同时行 ACL 重建的半月板修复与不重建的半月板修复之间无差异。
治疗学 4 级。请参阅作者说明，以获取完整的证据水平描述。
