Warwick Clinical Trials Unit, Clinical Sciences and Research Laboratories, University Hospital Coventry and Warwickshire, Coventry CV22DX, United Kingdom.
Warwick Clinical Trials Unit, University of Warwick, Coventry CV47AL, United Kingdom.
Knee. 2022 Oct;38:117-131. doi: 10.1016/j.knee.2022.07.002. Epub 2022 Aug 27.
Meniscal tears affect 222 per 100,000 of the population and can be managed non-operatively or operatively with an arthroscopic partial meniscectomy (APM), meniscal repair or meniscal transplantation. The purpose of this review is to summarise the outcomes following treatment with a meniscal tear and explore correlations between outcomes.
A systematic review was performed of MEDLINE, EMBASE, AMED and the Cochrane Central Register of Controlled Trials to identify prospective studies describing the outcomes of patients with a meniscal tear. Comparisons were made of outcomes between APM and non-operative groups. Outcomes were graphically presented over time for all treatment interventions. Pearson's correlations were calculated between outcome timepoints.
35 studies were included, 28 reported outcomes following APM; four following meniscal repair and three following meniscal transplant. Graphical plots demonstrated a sustained improvement for all treatment interventions. A moderate to very strong correlation was reported between baseline and three-month outcomes. In the medium term, there was small significant difference in outcome between APM and non-operative measures (SMD 0.17; 95 % CI 0.04, 0.29), however, this was not clinically significant.
Patients with a meniscal tear demonstrated a sustained initial improvement in function scores, which was true of all treatments examined. APM may have little benefit in older people, however, previous trials did not include patients who meet the current indications for surgery as a result the findings should not be generalised to all patients with a meniscal tear. Further trials are required in patients who meet current operative indications.
半月板撕裂影响每 10 万人中有 222 人，可通过关节镜下部分半月板切除术 (APM)、半月板修复或半月板移植进行非手术或手术治疗。本综述的目的是总结半月板撕裂治疗后的结果，并探讨结果之间的相关性。
对 MEDLINE、EMBASE、AMED 和 Cochrane 对照试验中心注册库进行系统评价，以确定描述半月板撕裂患者结局的前瞻性研究。比较了 APM 与非手术组的结果。所有治疗干预措施的结果均随时间以图形方式呈现。计算了结果时间点之间的 Pearson 相关性。
共纳入 35 项研究，其中 28 项报告了 APM 后的结果；4 项报告了半月板修复后的结果，3 项报告了半月板移植后的结果。图形图表明所有治疗干预措施均持续改善。报告了基线和三个月结果之间存在中度至非常强的相关性。从中期来看，APM 和非手术措施之间的结果存在微小但显著的差异（SMD 0.17；95%CI 0.04，0.29），但无临床意义。
半月板撕裂患者的功能评分最初持续改善，所有检查的治疗方法均如此。APM 对老年人可能益处不大，但以前的试验并未纳入符合当前手术指征的患者，因此这些发现不应推广到所有半月板撕裂患者。需要在符合当前手术指征的患者中进行进一步的试验。
