Boksh Khalis, E T Shepherd Duncan, M Espino Daniel, Ghosh Arijit, Aujla Randeep, Boutefnouchet Tarek
Department of Biomedical Engineering, University of Birmingham, Birmingham, UK.
Leicester Academic Knee Unit, University Hospitals of Leicester NHS Trust, Leicester, UK.
Knee Surg Sports Traumatol Arthrosc. 2025 Mar;33(3):888-906. doi: 10.1002/ksa.12410. Epub 2024 Aug 9.
To perform a systematic review and meta-analysis of the existing literature on meniscal centralisation procedures, analysing its impact on meniscal extrusion, joint biomechanics and clinical and radiological outcome measures.
The Cochrane Controlled Register of Trials, PubMed (MEDLINE) and Embase were used to perform a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. Biomechanical studies on healthy animal or human cadaveric knee joints that assessed meniscal extrusion or tibiofemoral contact mechanics (contact area and pressure) following centralization for meniscal pathologies were included. For clinical studies, those that prospectively or retrospectively assessed patient-reported outcome measures (PROMs), postoperative knee motion, complications and radiological extrusion following centralization for meniscal pathologies were included.
Fifteen studies were included in the analysis, comprising eight biomechanical, six clinical and one both. There were 92 knee specimens for biomechanical testing, of which 40 were human cadaveric and 52 porcine models. Biomechanical data revealed centralization to be commonly performed for posterior meniscal root tears and significantly reduced extrusion and contact pressure whilst improving contact area following a tear (p < 0.00001). Centralization restored extrusion to that of the native knee at all flexion angles described (0-90°, p = 0.25) and, compared to the torn state, brought tibiofemoral contact mechanics 3.2-5.0 times closer to the native state. Clinical data showed that 158 patients underwent centralization for extrusion. It improved postoperative Knee Injury and Osteoarthritis Outcome score (KOOS) (p = 0.006) and Lysholm scores (p < 0.00001) at 25.0 months, maintained extrusion reduction at 17.1 months (p < 0.00001) and preserved knee motion.
Centralisation for various meniscal injuries associated with extrusion can reduce meniscal extrusion and improve joint biomechanics, along with clinical and radiological outcomes. Existing evidence is still scarce and exhibits a notable amount of methodological heterogeneity.
Systematic review of Level IV evidence.
对现有的关于半月板复位手术的文献进行系统评价和荟萃分析，分析其对半月板挤出、关节生物力学以及临床和影像学结果指标的影响。
使用Cochrane对照试验注册库、PubMed（MEDLINE）和Embase，按照系统评价和荟萃分析的首选报告项目标准进行系统评价。纳入对健康动物或人体尸体膝关节进行的生物力学研究，这些研究评估了半月板病变复位后半月板挤出或胫股接触力学（接触面积和压力）情况。对于临床研究，纳入那些前瞻性或回顾性评估患者报告结局指标（PROMs）、术后膝关节活动度、并发症以及半月板病变复位后的影像学挤出情况的研究。
分析纳入了15项研究，其中8项生物力学研究、6项临床研究和1项兼具两者的研究。有92个膝关节标本用于生物力学测试，其中40个是人体尸体标本，52个是猪模型。生物力学数据显示，半月板后根部撕裂通常进行复位手术，复位后显著减少了挤出和接触压力，同时在撕裂后改善了接触面积（p < 0.00001）。在所述的所有屈曲角度（0 - 90°，p = 0.25）下复位使挤出恢复到正常膝关节水平，并且与撕裂状态相比，使胫股接触力学比正常状态接近3.2 - 5.0倍。临床数据表明，158例患者因半月板挤出接受了复位手术。术后25.0个月时膝关节损伤和骨关节炎结局评分（KOOS）（p = 0.006）和Lysholm评分（p < 0.00001）得到改善，在17.1个月时保持挤出减少（p < 0.00001），并维持膝关节活动度。
针对与挤出相关的各种半月板损伤进行复位可减少半月板挤出，改善关节生物力学以及临床和影像学结果。现有证据仍然稀少，且存在显著的方法学异质性。
IV级证据的系统评价。
