CHU Sainte-Justine, Montréal, 7905-3175, Côte Ste-Catherine, QC, H3T 1C5, Canada.
Faculty of Medicine, Université de Montréal, 2900 Boul. Edouard-Montpetit, Montreal, QC, H3T 1J4, Canada.
BMC Musculoskelet Disord. 2024 Jul 13;25(1):541. doi: 10.1186/s12891-024-07644-2.
Meniscal repair should be the gold standard. However, the meniscus is poorly vascularized and even an excellent meniscus repair may not heal. Therefore, numerous studies and systematic reviews have been carried out on platelet-rich plasma (PRP), mesenchymal stem cells (MSCs) and fibrin clots for meniscal augmentation, but the results remain controversial. This systematic review aimed to identify other emerging strategies for meniscal repair augmentation and to assess whether there are different avenues to explore in this field.
A systematic literature review was conducted in August 2022. PubMed, Ovid MEDLINE(R) all, Ovid All EBM Reviews, Ovid Embase and ISI Web of Science databases were searched. In Vivo animal and human studies concerning the biological augmentation of meniscal lesions by factors other than PRP, MSCs or fibrin clots were included. Cartilage-only studies, previous systematic reviews and expert opinions were excluded. All data were analyzed by two independent reviewers.
Of 8965 studies only nineteen studies covering 12 different factors met the inclusion criteria. Eight studies investigated the use of growth factors for meniscal biologic augmentation, such as vascular endothelial growth factor or bone morphogenic protein 7. Five studies reported on cell therapy and six studies focused on other factors such as hyaluronic acid, simvastatin or atelocollagen. Most studies (n = 18) were performed on animal models with gross observation and histological evaluation as outcomes. Polymerase chain reaction and immunohistochemistry were also common. Biomechanical testing was the object of only two studies.
Although several augmentation strategies have been attempted, none has yielded conclusive results, testifying to a lack of understanding with regard to meniscal healing. More research is needed to better understand the pathways that regulate meniscus repair and how to act positively on them.
Systematic review of case-control and animal laboratory studies.
半月板修复应该是金标准。然而，半月板的血管化程度很差，即使是出色的半月板修复也可能无法愈合。因此，已经进行了许多关于富血小板血浆（PRP）、间充质干细胞（MSCs）和纤维蛋白凝块用于半月板增强的研究和系统评价，但结果仍存在争议。本系统评价旨在确定半月板修复增强的其他新兴策略，并评估在该领域是否有不同的途径可以探索。
2022 年 8 月进行了系统文献回顾。检索了 PubMed、Ovid MEDLINE（R）All、Ovid All EBM Reviews、Ovid Embase 和 ISI Web of Science 数据库。纳入了通过 PRP、MSCs 或纤维蛋白凝块以外的因素对半月板病变进行体内动物和人体研究的文章。仅包含软骨的研究、以前的系统评价和专家意见被排除在外。所有数据均由两名独立评审员进行分析。
在 8965 项研究中，只有 19 项研究涵盖了 12 种不同的因素，符合纳入标准。八项研究调查了生长因子（如血管内皮生长因子或骨形态发生蛋白 7）用于半月板生物增强的用途。五项研究报告了细胞治疗，六项研究侧重于其他因素，如透明质酸、辛伐他汀或去端胶原。大多数研究（n=18）是在动物模型上进行的，以大体观察和组织学评估为结果。聚合酶链反应和免疫组织化学也很常见。只有两项研究的对象是生物力学测试。
尽管已经尝试了几种增强策略，但没有一种产生了确凿的结果，这证明了对半月板愈合的理解不足。需要更多的研究来更好地了解调节半月板修复的途径以及如何对其产生积极影响。
病例对照和动物实验室研究的系统评价。
