Department of Orthopaedic Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
Department of Orthopaedic Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
Knee. 2022 Oct;38:91-106. doi: 10.1016/j.knee.2022.07.007. Epub 2022 Aug 11.
Considerable interindividual variation in meniscal microvascularization has been reported. The purpose of this review was to identify which patient characteristics affect meniscal microvascularization and provide a structured overview of angiogenic therapies that influence meniscal neovascularization.
A systematic literature search was undertaken using PubMed, Embase, Web of Science, Cochrane library and Emcare from inception to November 2021. Studies reporting on (1) Patient characteristics that affect meniscal microvascularization, or (2) Therapies that induce neovascularization in meniscal tissue were included. Studies were graded in quality using the Anatomical Quality Assessment (AQUA) tool. The study was registered with PROSPERO(ID:CRD42021242479).
Thirteen studies reported on patient characteristics and eleven on angiogenic therapies. The influence of Age, Degenerative knee, Gender, and Race was reported. Age is the most studied factor. The entire meniscus is vascularized around birth. With increasing age, vascularization decreases from the inner to the peripheral margin. Around 11 years, blood vessels are primarily located in the peripheral third of the menisci. There seems to be a further decrease in vascularization with increasing age in adults, yet conflicting literature exists. Degenerative changes of the knee also seem to influence meniscal vascularization, but evidence is limited. Angiogenic therapies to improve meniscal vascularization have only been studied in preclinical setting. The use of synovial flap transplantation, stem cell therapy, vascular endothelial growth factor, and angiogenin has shown promising results.
To decrease failure rates of meniscal repair, a better understanding of patient-specific vascular anatomy is essential. Translational clinical research is needed to investigate the clinical value of angiogenic therapies.
已有研究报道半月板的微血管化存在显著的个体间差异。本综述旨在确定哪些患者特征会影响半月板微血管化，并对影响半月板新生血管化的血管生成治疗方法进行系统综述。
我们对PubMed、Embase、Web of Science、Cochrane 图书馆和 Emcare 进行了系统的文献检索，检索时间从建库至 2021 年 11 月。本研究纳入了（1）影响半月板微血管化的患者特征的研究，或（2）诱导半月板组织新生血管化的治疗方法的研究。使用解剖质量评估（AQUA）工具对研究进行质量分级。本研究已在 PROSPERO（注册号：CRD42021242479）注册。
有 13 项研究报道了患者特征，11 项研究报道了血管生成治疗方法。年龄、退行性膝关节、性别和种族的影响都有报道。年龄是研究最多的因素。半月板在出生时就已完全血管化。随着年龄的增长，血管化从半月板的内缘向周围缘减少。大约在 11 岁时，血管主要位于半月板的外周三分之一。在成年人中，随着年龄的增长，血管化似乎进一步减少，但文献存在争议。膝关节的退行性改变似乎也会影响半月板的血管化，但证据有限。改善半月板血管化的血管生成治疗方法仅在临床前研究中进行了研究。滑膜瓣移植、干细胞治疗、血管内皮生长因子和血管生成素的应用显示出了有前景的结果。
为了降低半月板修复的失败率，必须更好地了解患者特定的血管解剖结构。需要进行转化临床研究来探讨血管生成治疗的临床价值。
